Large Basilar Trunk Aneurysm Discovered Incidentally in a Patient with Ischaemic Stroke: Case Report

Summary: Many anomalies can be observed in the basilar trunk, such as aneurysms. Basilar trunk aneurysms are rare with a low reported prevalence. In this study, we describe a case of ischaemic stroke revealed by a basilar trunk aneurysm associated with venous thromboembolic disease. The patient was 60 years old and had no specific pathological history. She was seen for a sudden onset of right hemiplegia associated with dysarthria that had been present for 12 hours. The physical examination revealed a pyramidal syndrome and an altered general condition. An emergency cerebral computed tomography (CT) scan showed evidence of a cerebrovascular accident associated with a saccular aneurysm. We adopted the diagnosis of a deep left sylvian stroke associated with a superficial right sylvian stroke in the setting of an incidentally discovered basilar trunk aneurysm. On the 9^ème day of hospitalisation, the patient experienced sudden onset of respiratory distress in conjunction with a warm, painful swelling of the right leg. TTE revealed signs of pulmonary embolism, with thrombi in the inferior vena cava and right atrium. Pulmonary embolism was highly probable, with a modified Geneva score of 15. We adopted the diagnosis of DVA complicated by pulmonary embolism in the setting of a basilar trunk aneurysm. The patient was transferred to the cardiology department, where she received oxygen therapy and thrombolysis with streptokinase. The immediate outcome 6 hours later was the sudden death of the patient due to the onset of cardiogenic shock.