Hyperdense basilar artery identified on unenhanced head CT in three cases of pediatric basilar artery occlusion

A board certified neuroradiologist reviewed the imaging of all three patients to confirm the presence of BAO on CT angiography (CTA) and quantitatively measure the BA density on UHCT as previously described [7].3 Cases 3.1 Case 1 An 8-year-old male with a past medical history of attention deficit hyperactivity disorder (ADHD), hypoplastic right heart and pulmonary atresia status post Fontan procedure, presented to the Emergency Department (ED) for evaluation of altered mental status. According to the American Heart Association (AHA), pediatric patients with posterior circulation stroke “present at [a] median age of 7–8 years, are predominantly male (67–77%), and are previously healthy children in the majority [of] cases [10].” Death or severe neurological impairment after BAO is seen in about 50% of cases [9], however given that the majority of data surrounding pediatric basilar artery stroke is derived from case studies, this value may under represent the true morbidity and mortality of pediatric BAO, as case studies are often biased toward reporting of good clinical outcomes. [...]the era of mechanical thrombectomy has considerably elevated the importance of early identification of acute BAO in both adults and children [12]. A recent meta-analysis examining the relationship between recanalization of acute BAO and clinical outcomes from 45 studies (n = 2056) reported a two-fold and 1.5-fold reduction in mortality and risk of death or dependency, respectively [13].