Edit concept Question Editor Create issue ticket

Basilar Artery Occlusion

Occlusion and Stenosis of Basilar Artery

Basilar artery occlusion is a life-threatening vascular pathology that can initially present with relatively mild and nonspecific symptoms. Eventually, quadriparesis, dysarthria, altered level of consciousness, and ocular abnormalities may ensue and put the patient at great risk. A presumptive diagnosis can be made during the clinical assessment, but imaging studies are needed in order to confirm that the basilar artery is the site of the occlusion. Catheter angiography and either computed tomography (CT) angiography or magnetic resonance (MR) angiography are recommended modalities.


Presentation

Signs and symptoms of basilar artery occlusion vary depending on the extent (but also the site) of the occlusion. Unlike the majority of cerebrovascular insults, the clinical course is frequently gradual and starts with relatively mild and nonspecific complaints such as a headache and possibly vertigo, which mimics a transient ischemic attack (TIA) and delays the diagnosis [1] [2] [3]. Eventually, the typical signs of basilar artery occlusion appear - altered mental state (patients are often in a coma), hemiparesis or quadriparesis, dysphagia, dysarthria, and other neurological deficits [1] [2] [3] [4]. Additional findings that could be encountered are nausea, vomiting, bulbar dysfunction, locked-in syndrome, ataxia, deficits of the extraocular muscles, and nystagmus, as well as the hearing loss [1] [2] [3] [4]. Epileptic-like events characterized by bilateral twitching or shaking may be present [2]. Specific symptoms appear in relation to the site of occlusion [5]. For example, occlusion of the middle segment of the basilar artery (which supplies the lateral and medial pons) can result in ipsilateral loss of sensation of the face, dysmetria, and contralateral hemiparesis [5]. Studies that have investigated basilar artery occlusion in both children and adults show a marked predominance of male gender [3] [4].

Coarctation of the Aorta
  • We report a case of an 8-year-old girl with posterior fossa abnormalities, haemangioma, arterial lesions, cardiac abnormalities or coarctation of the aorta and eye abnormalities syndrome with right carotid aplasia and complete basilar occlusion.[ncbi.nlm.nih.gov]
Raynaud Phenomenon
  • A previously healthy 22-year-old man presented with thoracic outlet syndrome manifesting as Raynaud's phenomenon in the left hand and embolic occlusion of the basilar artery.[ncbi.nlm.nih.gov]
Sepsis
  • Despite aggressive surgery, sepsis persisted, and therapy was limited by uncontrollable coagulopathy and catecholamine refractory shock after 15 days.[ncbi.nlm.nih.gov]
Hyperthermia
  • Successful treatment of central hyperthermia in patients with brainstem infarction by baclofen has not been described. Following basilar artery occlusion, a 68-year-old female developed prolonged hyperthermia.[ncbi.nlm.nih.gov]
Refractory Shock
  • Despite aggressive surgery, sepsis persisted, and therapy was limited by uncontrollable coagulopathy and catecholamine refractory shock after 15 days.[ncbi.nlm.nih.gov]
Flushing
  • Heparin was only applied for catheter flushing (500 IU/h). The patient with the atherothrombotic occlusion was treated with additional percutaneous transluminal angioplasty and stenting.[ncbi.nlm.nih.gov]
Fracture
  • Head computed tomography (CT) revealed an open depressed fracture, an acute epidural hematoma 1 cm thick in the left middle frontal fossa, and a longitudinal fracture of the clivus. Emergency removal of the hematoma was performed with cranioplasty.[ncbi.nlm.nih.gov]
  • Traumatic Basilar Artery Occlusion Caused by a Fracture of the Clivus.[medical-dictionary.thefreedictionary.com]
Contusion
  • Cerebral angiography is recommended in a patient in a deep coma without massive brain contusion at the early stage of head injury to identify the possibility of vertebrobasilar artery occlusion in a clivus fracture.[ncbi.nlm.nih.gov]
Tinnitus
  • Major neurological symptoms include deafness on the affected side, the weakness of facial muscles, dizziness true (system), nausea and vomiting, nystagmus, tinnitus, and cerebellar ataxia, Horner's syndrome, paresis of horizontal gaze.[minclinic.ru]
  • Hypaesthesia or anaesthesia •Cerebellar signs •Vertigo,nausea, vomiting, directional nystagmus •Disturbance of respiration, blood pressure and heart rate •Headache, •Incontinence •Oculomotor signs •Facial palsy •Double vision, strabismus, skew deviation •Tinnitus[omicsonline.org]
  • […] mentioned in table 2 included “malaise,” described as a sensation of impending death or general uneasiness in 10 patients; breathing difficulties in four patients; abnormal movements referred to as “seizures” in five patients; and sudden hearing loss or tinnitus[jnnp.bmj.com]
Sudden Hearing Loss
Claustrophobia
  • Claustrophobia is another important adverse factor when using MRI as an imaging study.[symptoma.com]
Dysmetria
  • We herein report the case of a 32-year-old woman with sudden onset ataxia, limb dysmetria and somnolence. Emergency radiological findings showed bilateral cerebellar and thalamic infarctions as a result of a basilar artery occlusion.[ncbi.nlm.nih.gov]
  • For example, occlusion of the middle segment of the basilar artery (which supplies the lateral and medial pons) can result in ipsilateral loss of sensation of the face, dysmetria, and contralateral hemiparesis.[symptoma.com]
  • Fig. 1 A 63-year-old female with a history of atrial fibrillation, but not anticoagulated, presented with 24 h of ophthalmoplegia, dysarthria, dysmetria, and a fluctuating level of consciousness.[karger.com]
Confusion
  • A 31-year-old man sought treatment for confusion, dysarthria, and right-sided weakness. He soon became unresponsive and was found to have a vertebral artery dissection and an associated basilar artery embolism.[ncbi.nlm.nih.gov]
  • Mental changes were usually reported by the patient’s relatives using descriptive terms such as “strange,” “disoriented,” or “confused.”[jnnp.bmj.com]
Involuntary Movements
  • The clinical diagnosis of basilar artery occlusion is often difficult because the initial neurologic findings, most frequently hemiparesis, involuntary movements, or headache, are often transient and can suggest complicated migraine, seizures, or both[ncbi.nlm.nih.gov]

Workup

Because of the insidious onset of symptoms, the physician must suspect basilar artery occlusion if any of the abovementioned manifestations are observed. Cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, or prior vascular insults are present in a number of patients [3], meaning that a fully obtained patient history can be of great help in raising clinical suspicion. The neurological exam, however, is the crucial component of the workup, as a detailed assessment of cranial nerve and brainstem functions might reveal the exact site of the lesion [2]. To make a definite diagnosis, imaging studies need to be employed. Computed tomography (CT) is usually the first-line study in patients who exhibit stroke-like symptoms, but the location of the basilar artery is a significant barrier for adequate CT imaging [5]. On the other hand, magnetic resonance imaging (MRI) is a more suitable study that can delineate the soft tissues in more details, particularly through diffusion-weighted imaging (DWI). Importantly, the procedure is time-consuming and is contraindicated for patients with pacemakers or foreign bodies made of metal [5]. Claustrophobia is another important adverse factor when using MRI as an imaging study [5]. Studies recommend conventional catheter cerebral angiography, and either CT and MR angiography, as these procedures provide a precise view of the desired blood vessels [5] [6]. MR angiography with contrast is particularly useful for evaluation of vertebrobasilar vessels [6].

Treatment

  • The following data were collected: baseline characteristics, risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, localization of occlusion, time to therapy, recanalization rate, post-treatment imaging findings.[ncbi.nlm.nih.gov]

Prognosis

  • DWI, posterior circulation Acute Stroke Prognosis Early CT Score of 7 (versus CONCLUSIONS: This study suggested that initial infarction severity and posterior circulation Acute Stroke Prognosis Early CT Score on a pretreatment DWI are independent predictors[ncbi.nlm.nih.gov]

Etiology

  • In the cases of pure basilar artery occlusion, the most common causes were trauma and arteritis, but in most such cases, the etiology could not be determined.[ncbi.nlm.nih.gov]
  • In both the cases, extensive diagnostic work-up did not reveal the etiology.[thieme-connect.com]
  • Cerebrovascular accidents (CVAs) are one of the most serious etiologies for altered mental status.[westjem.com]

Epidemiology

  • Epidemiology and risk factors Basilar artery is the artery most often affected with atherosclerosis of all the intracranial arteries [ 1 ].[omicsonline.org]
  • Randomized control trials need to be performed. [1] Epidemiology [ edit ] The incidence of VBI increases with age and typically occurs in the seventh or eighth decade of life. [ citation needed ] Reflecting atherosclerosis, which is the most common cause[en.wikipedia.org]
  • Epidemiology Occurrence in the United States The frequency, incidence, and prevalence of basilar artery occlusion are not known.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Because cerebral vessel occlusions after burn injuries are reported rarely, the current literature was reviewed, and possible pathophysiological aspects are discussed.[ncbi.nlm.nih.gov]
  • Pathophysiology of ischemic stroke in the anterior inferior cerebellar artery basin Occlusion (blockage) inferior cerebellar artery front leads to the development of cerebral infarction of varying severity, because the size of this artery and its territory[minclinic.ru]
  • Pathophysiology Given the anatomy of the posterior circulation and the circle of Willis, the clinical manifestations of basilar artery thrombosis depend on the location of the occlusion, the extent of the thrombus, and the collateral flow.[emedicine.medscape.com]

Prevention

  • Delayed intra-arterial thrombolysis and vertebral artery coiling can be successfully used to treat basilar artery occlusion and prevent the recurrence of brainstem ischemia in children.[ncbi.nlm.nih.gov]
  • Treatment with methylprednisolone and MMF in addition to dual antiplatelet therapy has thus far prevented further relapses and was associated with a satisfactory neurological outcome.[thieme-connect.com]
  • Página 310 - A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. ‎[books.google.es]

References

Article

  1. Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol. 2011;10(11):1002-1014.
  2. Demel SL, Broderick JP. Basilar Occlusion Syndromes: An Update. Demaerschalk BM, ed. Neurohospitalist. 2015;5(3):142-150.
  3. Israeli-Korn SD, Schwammenthal Y, Yonash-Kimchi T, et al. Ischemic stroke due to acute basilar artery occlusion: proportion and outcomes. Isr Med Assoc J. 2010;12(11):671-675.
  4. Goeggel Simonetti B, Ritter B, Gautschi M, et al. Basilar artery stroke in childhood. Dev Med Child Neurol. 2013;55(1):65-70.
  5. Nouh A, Remke J, Ruland S. Ischemic Posterior Circulation Stroke: A Review of Anatomy, Clinical Presentations, Diagnosis, and Current Management. Front Neurol. 2014;5:30.
  6. Khan S, Rich P, Clifton A, Markus HS. Noninvasive detection of vertebral artery stenosis a comparison of contrast-enhanced MR angiography, CT angiography, and ultrasound. Stroke. 2009;40(11):3499–3503.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-06-28 10:17