2023 Volume 51 Issue 3 Pages 238-243
Caudal paramedian midbrain infarction (CPMI) is an extremely rare cerebrovascular disease associated with a unique symptom. Herein, we report a case of CPMI after stent-assisted coil embolization for an unruptured basilar tip aneurysm. To the best of our knowledge, this is the first case report of CPMI as a complication after interventional radiology (IVR). A 70-year-old woman was incidentally found to have a basilar tip aneurysm. After stent-assisted coil embolization for the aneurysm, the patient presented with bilateral ophthalmoplegia, bilateral limb ataxia, and dysarthria. Postoperative magnetic resonance imaging revealed bilateral CPMI, which was thought to be associated with IVR. During coil embolization for the caudal side aneurysm of the asymmetric basilar artery tip, ischemic complication involving perforating branches is unlikely to develop. However, retrospective evaluation of preoperative high-resolution cone-beam computed tomography revealed perforating branches arising from the dorsal aspect of the caudal side posterior cerebral artery, presuming inferior paramedian mesencephalic artery (IPMA). We speculated that the obliteration of these perforating branches caused bilateral CPMI. Clinical studies related to IPMA are scarce; therefore, detailed preoperative evaluation of perforating branches is crucial.
