The Silent Killer: An Autopsy Case of Basilar Artery Thrombosis With Diabetes Mellitus, Metabolic Dysfunction-Associated Steatotic Liver Disease, and Gastroesophageal Reflux Disease

We report a case of autopsy-confirmed basilar artery thrombosis in a 58-year-old male with a history of diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD), and gastroesophageal reflux disease (GERD). The patient presented with cardiopulmonary arrest while eating and died two hours after the initial collapse. Postmortem imaging could not identify a definitive cause of death. The autopsy revealed acute hemorrhagic infarcts in the brainstem, along with evidence of basilar artery thrombosis and severe arteriosclerosis. The presence of diabetes, MASLD, and GERD may have contributed to the development of arteriosclerosis and increased the risk of cardiovascular events. This case highlights the complex interplay between seemingly unrelated medical conditions and their potential to contribute to sudden and unexpected death. While diabetes and MASLD are often referred to as "silent killers," in this case, basilar artery thrombosis acted as the final "silent killer" for the patient. The autopsy revealed a complex web of silent killers, ultimately concluding that basilar artery embolism was the cause of death.