Basilar Artery Dissection Diagnosed Using Fluid-Attenuated Inversion Recovery and Managed with Stepwise Antithrombotic Therapy: A Case Report.

Introduction: Basilar artery dissection (BAD) is a rare cause of brainstem infarction, presenting with nonspecific symptoms and subtle radiographic findings, resulting in diagnostic delays. In this case, we aimed to highlight the value of fluid-attenuated inversion recovery (FLAIR) imaging in the early detection of BAD and evaluate the safety of a stepwise conservative treatment strategy. Case Presentation: We report a case of a middle-aged man with an acute brainstem infarction caused by isolated BAD. Initial magnetic resonance imaging revealed diffusion restriction in the pons and linear hyperintensity along the basilar artery on FLAIR imaging. Computed tomography angiogram revealed irregularity of the basilar artery lumen without aneurysmal dilation, which was then confirmed via digital subtraction angiography. The patient was managed conservatively with initial heparinization followed by cilostazol. Results of serial imaging showed no morphological progression, and the patient gradually improved, with only mild residual deficits. Conclusion: This case highlights the diagnostic value of FLAIR imaging in the early detection of BAD and supports the safety and potential efficacy of a stepwise antithrombotic strategy - initial anticoagulation with heparin followed by antiplatelet therapy with cilostazol - in the absence of hemorrhagic risk.