PMC8240890_01
Computed tomography images. (A) Sagittal maximized intensity projection (MIP) image showing basilar artery herniation into the clivus fracture and its trans-sinussoidal course. (B) Three-dimensional (3D) reconstruction of the skull base and the circle of Willis' region displaying the basilar artery entrapment
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Contrast-enhanced computed tomography (CT) scanning of his head and neck showed extensive traumatic subarachnoid hemorrhaging, a left-sided subdural hematoma, and an unusual course of the basilar artery with anterior deviation into the posterior aspect of the left sphenoid sinus that was filled with blood due to the extensive sinonasal fractures. (Fig. 1A). Three-dimensional (3D) reconstructions revealed that the basilar artery herniation occurred through a longitudinal clival fracture (Fig. 1B).
Axial magnetic resonance images. Sequential T2-weighted images (from caudal toward cranial) of the basilar artery pathway showing herniation of the artery into the clivus fracture and the trans-sinussoidal course through the left sphenoidal sinus.
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On hospital day 2, magnetic resonance imaging (MRI) of the brain confirmed the herniation of the basilar artery (Fig. 2) and showed severe mesencephalic and pontine ischemia (Fig. 3).