Case Studies
Case 7: A 63-year-old lady found collapsed at home
A 63-year-old lady is found collapsed at home. She is blue lighted up to Casualty where she is found to be unresponsive with pin point pupils and requires ventilatory support. She has normal blood tests, a negative toxicology screen and a normal CT scan.
Your Answer:
Correct answer: Basilar artery thrombosis. The sudden onset of an event which causes someone to collapse, be unresponsive and require ventilatory support is relatively large insomuch as it is typically vascular in nature and could involve any territory. The clue is that she has pin point pupils which points towards a problem within the brain stem and the most likely diagnosis is a basilar artery thrombosis given the normality of the scan.
Your Answer:
Correct answer: In order to show that she has occluded her basilar artery she needs detailed imaging of the posterior fossa and in particular that vessel and thus MRI or some form of angiography is necessary.
Your Answer:
Correct answer: The prognosis is extremely poor although in the acute situation if she has been found within a few hours of the event there is some merit in considering giving thrombolysis to try and dissolve the clot in the basilar artery.