Basilar artery thrombosis due to hyperhomocysteinemia treated conservatively: a therapeutic success

Deepak Sharma, Virendra Atam, Avirup Majumdar, Mohammed Hashim


Basilar artery thrombosis is a rare and potentially fatal cause of posterior circulation stroke. Among the various etiologies, hyperhomocysteinemia is crucial and often under diagnosed, especially in developing countries. Authors describe the case of a 15-year male who presented with 1-day history of headache, vomiting and altered mental status. Non-contrast CT Head revealed multiple acute infarcts in posterior circulation of brain. Laboratory investigations revealed hyperhomocysteinemia. Contrast enhanced MRI Brain showed acute infarcts in bilateral cerebellar hemispheres, pons, midbrain, medulla and vermis. MR venography was suggestive of Basilar Artery thrombosis. Thrombolysis was not done due to delayed presentation; hence authors resorted to conservative management with folic acid and vitamin B supplementation. The patient showed gradual clinical improvement and had complete clinical recovery during follow up visit. A favorable outcome with conservative management of basilar artery thrombosis is rarely reported in literature.


Basilar infarct, Basilar stroke, Hyperhomocysteinemia, Posterior circulation stroke, Young stroke

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Reinemeyer NE, Tadi P, Lui F. Basilar Artery Thrombosis. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing; 2019.

Demel SL, Broderick JP. Basilar Occlusion Syndromes: An Update. Neurohospitalist. 2015;5(3):142-50.

Schonewille WJ, Algra A, Serena J, Molina CA, Kappelle LJ. Outcome in patients with basilar artery occlusion treated conventionally. J Neurol, Neurosurg Psychiat. 2005;76:1238-41.

Kim JM, Park KY, Shin DW, Park MS, Kwon OS. Relation of serum homocysteine levels to cerebral artery calcification and atherosclerosis. Atherosclerosis. 2016;254:200-4.

Modi M, Prabhakar S, Majumdar S, Khullar M, Lal V, Das CP. Hyperhomocysteinemia as a risk factor for ischemic stroke: An Indian scenario. Neurol India. 2005;53:297-301.

Tan NC, Venketasubramanian N, Saw SM, Tjia HT. Hyperhomocyst(e)inemia and risk of ischemic stroke among young Asian adults. Stroke. 2002 Aug;33(8):1956-62.

Ashjazadeh N, Fathi M, Shariat A. Evaluation of Homocysteine Level as a Risk Factor among Patients with Ischemic Stroke and Its Subtypes. Iran J Med Sci. 2013 Sep;38(3):233-9.

Chikkannaiah M, Lo WD. Childhood basilar artery occlusion: a report of 5 cases and review of the literature. J Child Neurol. 2014 May;29(5):633-45.

Eikelboom JW, Hankey GJ, Anand SS, Lofthouse E, Staples N, Baker RI. Association between high homocysteine and ischemic stroke due to large and small artery disease but not other etiologic subtypes of ischemic stroke. Stroke. 2000;31:1069-75.

Stein JH, McBride PE. Hyperhomocysteinemia and atherosclerotic vascular disease. Pathophysiology, screening and treatment. Arch Intern Med. 1998;158:1301-06.

Arrastia RD. Homocysteine and neurologic disease. Arch Neurol. 2000;57:1422-6.

Evers S, Koch HG, Grotemeyer KH, Lange B, Deufel T, Ringelstein EB. Features, symptoms and neurophysiological findings in stroke associated with hyperhomocysteinemia. Arch Neurol. 1997;54:1276-82.

Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med. 2006;354(15):1567-77.