Basilar artery thrombosis in a 20-year-old pregnant patient – difficulties in establishing the aetiology

Dear Editor,
I would like to present a case of a 20-year-old pregnant patient with basilar artery thrombosis and our struggle to establish its aetiology in this particular patient.
Pregnancy constitutes a risk factor for both arterial and venous cerebral thrombosis. The reported incidence of ischaemic stroke in young adults is 10.8/100,000/year [1]. During pregnancy the incidence of ischaemic stroke is estimated at 12.2/100,000 pregnancies [2]. The most common causes of non-haemorrhagic stroke in pregnancy are cardioembolism, coagulopathy and preeclampsia/eclampsia. Nevertheless, establishing the aetiology of stroke in pregnancy can be challenging.
A 20-year-old pregnant patient in the 8th week of gestation was admitted to Department of Anaesthesiology and Intensive Care (ICU) of a tertiary medical centre following ischaemic stroke of the left cerebellar hemisphere. The patient was initially admitted to emergency department (ER) of a district general hospital with symptoms of headache, vertigo and impaired balance. These symptoms were present from the morning hours of the previous day, however the patient did not seek medical attention at that time. On admission to ER the patient was alert, non-responsive, meningeal signs were negative, pupils were equal, right 3rd cranial nerve paresis was present, vertical movements of eyeballs were observed, flexion of right limbs and extension of left limbs to pain was elicited and the Babinski sign was present bilaterally. Due to the risk of aspiration, the patient was intubated and mechanical ventilation was commenced. Computed tomography (CT) revealed a 9 mm thrombus in the basilar artery and signs of left cerebellar hemisphere ischaemia. Head and neck angio-CT confirmed a thrombus in the basilar artery with no signs of vertebral artery dissection. Medical and drug history were negative. The patient underwent uncomplicated caesarean section 3 years earlier. Family history revealed very short height in the mother and grand­mother. On admission to ICU the neurological status of the patient did not change compared to initial evaluation. Both neurological and interventional radio­logy consultations were requested, however the patient was disqualified from intravenous thrombolysis and percutaneous thrombectomy due to late presentation (over 24 hrs). Medical treatment of cerebral oedema was commenced (mannitol) and the patient was started on antiplatelet (acetylsalicylic acid 150 mg) and anticoagulant...


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