Impaired sense of smell: an early sign of top of the basilar artery syndrome

Top of the basilar artery syndrome is a rare condition that can cause intracranial ischemia. In this syndrome, there may be mild findings as well as permanent neurological disorders and death.A 60-year-old male patient, who applied to the emergency department with complaints of olfactory and speech disorder, was diagnosed with top of the basilar artery syndrome after neurological examination and cranial imaging, and reperfusion therapy could not be performed due to contraindications. In the following time, the neurological symptoms progressed and the patient was intubated due to the development of respiratory failure. The patient died in the 12th hour of his admission to the emergency department. Impaired sense of smell may be the presenting finding of top of the basilar artery syndrome, especially in patients with risk factors for cranial ischemia. Emergency physicians should be careful in this regard and provide early diagnosis and treatment.