Unmasking the Basilar Culprit: A Case of Acute Posterior Circulation Stroke in a Diabetic Septuagenarian.

A 76-year-old man with poorly controlled diabetes mellitus, with an HbA1c of 10.9% (4.7%-6.4%), presents with acute right facial numbness, transient right eye foggy vision, and near syncope. Neuroimaging revealed substantial basilar artery stenosis with acute infarction in the region of the right posterior cerebral artery, impacting the medial temporal, occipital, thalamus, and midbrain. Although basilar artery stenosis is uncommon, its combination with poorly managed diabetes and posterior circulation involvement makes therapy difficult. Partial neurological recovery was observed with dual antiplatelet treatment and intensive risk factor management. Basilar artery stenosis has a poor prognosis; however, early detection, medical therapy, and comorbidity control can improve patient outcomes and reduce recurrence risk. The example further emphasizes the necessity of preventative treatment in high-risk patients and the link between diabetes control and posterior circulation stroke risk.