Fusiform Basilar Artery Aneurysm Associated with Pontine Lacunar Infarctions

A 47-year-old woman with hypertension and chronic kidney disease (CKD) was admitted for clinical syndrome of hypertensive urgency. On initial examination, she was found to have right-sided weakness and gait ataxia, while rest of the neurological examination was within normal limits. The patient reported that these symptoms gradually started 6 month ago, for which she never seek medical attention. Magnetic resonance angiography (MRA) showed aneurysmal distention of the basilar artery. (Fig. A) The artery measured 58 mm in length and 16 mm in diameter, pressing on the right pons. (Fig. B) Lacunar infarcts were also revealed in left pons, most likely caused by perforator occlusion within the aneurysm. Antiplatelet, antihypertensive, and lipidlowering therapy was initiated, and patient was discharged with close follow-up by neurology and neurointervention divisions.