Left Vertebral Artery Occlusion

67 year old male presented with dizziness and hand numbness. Later he became less responsive and had to be intubated for airway protection. Initial CT scan of his brain revealed no acute abnormalities.

MRA brain and neck showed left vertebral artery occlusion (see image above). MRI brain revealed acute ischemic changes in the left cerebellum.

Later, he became even less responsive. CT scan brain revealed extension of the stroke. Suboccipital craniotomy was performed by a neurosurgeon. Despite the surgery he lost all his brainstem reflexes. Nuclear medicine brain perfusion scan confirmed the diagnosis of brain death.