If a completed stroke occurs, the infarctpattern depends on the site of the vascular pathology. Medullary infarctions or infarcts of the PICA territory are observed if the stenotic process is located proximal to, or directly at the origin of the PICA. Ischemia within the BA, SCA, and posterior ce­rebral artery (PCA) territory occur more often in stenotic processes distal to the PICA branch. Artery-to-artery em­bolic events from atheromatous plaques located in the intracranial VA may also result in distal patterns of infarc­tion. In our patient, a VA-derived thrombus caused a distal BA occlusion with clinically fluctuating signs of a “top-of­the-basilar-syndrome” (Caplan 1980, Mehler 1989). In cases of persisting occlusion this may lead to ischemic infarctions in upper pons, midbrain, cerebellum within the SCA territory, thalamus, and the PCA territory. How­ever, the extent may vary, as in our patient who only had a partial SCA infarction. From this we can assume that although the occlusion began at the mid-basilar level, it must have extended to the head of the BA. We can also conclude that our patient’sclinicalsymptomswereindi­cative of distal BA involvement, as they were mainly com­prised of a mesencephalic dysfunction (transient third nerve palsy and fluctuation in consciousness). Because of the fluctuating symptoms, lack of ischemic signs on cere­bral CT, and verification of the BA occlusion by DSA, an intracranial thrombolysis was performed which led to complete recanalization 6 hours after the onset of his symptoms. Furthermore, balloon dilatation of the left high-grade VA stenosis was performed.