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].

• Nausea

  Clinical symptoms included nausea, vomiting, and rapid alteration of consciousness. Magnetic resonance imaging showed total occlusion of the basilar artery, and angiography confirmed VAD from the third to the fourth segments. [ncbi.nlm.nih.gov]

  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. [symptoma.com]

  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]

  Some of the common symptoms of a basilar artery stroke include the following: Balance difficulty Vertigo Double vision or loss of vision Loss of coordination Swallowing difficulty Difficulty pronouncing words Numbness Weakness in one-half of the body Nausea [verywell.com]

  During progression towards the final event, episodes of vertigo, nausea, and vomiting become more frequent. [jnnp.bmj.com]

• Vomiting

  Clinical symptoms included nausea, vomiting, and rapid alteration of consciousness. Magnetic resonance imaging showed total occlusion of the basilar artery, and angiography confirmed VAD from the third to the fourth segments. [ncbi.nlm.nih.gov]

  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. [symptoma.com]

  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]

  The arterial BP of the patient in the ER was 210/107 mmHg, and he was vomiting. His Glasgow-Liege Coma Scale score was 11 points, National Institutes of Health stroke scale was 24 points, and mRS 5. [e-coretvasa.cz]

  During progression towards the final event, episodes of vertigo, nausea, and vomiting become more frequent. [jnnp.bmj.com]

• 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]

• Fear

  Among the most feared and devastating strokes are ones caused by blockages in the brain's critical basilar artery system. [sciencedaily.com]

  Overview Infarcts in the distribution of the basilar artery are perhaps the most feared and devastating of all ischemic strokes. However, an important minority of patients can have good outcomes, especially with time-sensitive treatment approaches. [medlink.com]

  Basilar strokes are rare and the most feared of all strokes. The most common cause of basilar artery strokes is hardening of the arteries. The second most likely cause is a blood clot. [ohiostrokelawyer.com]

• Claustrophobia

  Claustrophobia is another important adverse factor when using MRI as an imaging study. [symptoma.com]

• Dizziness

  A 67-year-old woman presented with unilateral acute hearing loss with dizziness as a sole prodromal manifestation of basilar artery occlusion for 2 weeks before the appearance of motor and oculomotor deficits. [ncbi.nlm.nih.gov]

  Patients often complain of dizziness, and when asked to describe the sensations experienced, they report that "float", "rock", "move", "feeling of instability". [minclinic.ru]

  At 15:35 she’s feeling some dizziness. At 15:45 she complains about diplopia. At 16:00 she develops right sided weakness. At 16:45 she becomes tetraplegic, but is still arousable. At 17:00 she becomes comatose. [basicstrial.com]

  Vertigo, dizziness, nausea, vomiting and head or neck pain are the most common initial symptoms reported. 3, 9 – 12 Other common signs and symptoms include weakness, hemiparesis, ataxia, diplopia, pupillary abnormalities, speech difficulties and altered [westjem.com]

• Nystagmus

  Therefore, those with vertigo and nystagmus may be signaling a forthcoming stroke event, something that should be considered for clinicians seeing vertiginous patients. [ncbi.nlm.nih.gov]

  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. [symptoma.com]

  […] complete absence of any clinical deterioration between CTA and MRA makes basilar artery occlusion unlikely. 8,10] Symptoms consistent with basilar artery occlusion include limb paralysis, bulbar or pseudobulbar paralysis of the cranial nerve motor nuclei, nystagmus [medical-dictionary.thefreedictionary.com]

  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]

  •Decreased level of consciousness/coma •Hemiparesis /quadriparesis, hemiplegia/quadriplegia •Hypaesthesia or anaesthesia •Cerebellar signs •Vertigo,nausea, vomiting, directional nystagmus •Disturbance of respiration, blood pressure and heart rate •Headache [omicsonline.org]

• 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]

• Alteration of Consciousness

  Thirty hours after progressive alteration of consciousness, speech disturbances and left arm paresis, the child became comatose with decerebrate rigidity. A CT scan showed parenchymal ischaemic lesions. [ncbi.nlm.nih.gov]

• Reduced Consciousness

  and (2) gradual or stuttering course of posterior circulation symptoms such as blurred vision, balance disturbance, dysarthria, bilateral paresthesiae, or motor weakness, which finally become disabling and reduce consciousness. [stroke.ahajournals.org]

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].

• Dyslipidemia

  Cardiovascular risk factors, such as hypertension, diabetes mellitus, dyslipidemia, or prior vascular insults are present in a number of patients, meaning that a fully obtained patient history can be of great help in raising clinical suspicion. [symptoma.com]

  […] with age and typically occurs in the seventh or eighth decade of life. [ citation needed ] Reflecting atherosclerosis, which is the most common cause of VBI, it affects men twice as often as women and patients with hypertension, diabetes, smoking, and dyslipidemias [en.wikipedia.org]

  Fig. 2 A 54-year-old man with hypertension and dyslipidemia presented with nausea and vomiting, fluctuating left-sided weakness, and a fluctuating level of consciousness. [karger.com]

Although early arterial recanalization by thrombolytic agent has became the new trend of treatment, for some neurologists anticoagulant is still a conventional alternative treatment of basilar artery occlusion, especially in longer-existing ischemic deficits [ncbi.nlm.nih.gov]

Basilar artery occlusion is usually associated with a poor prognosis. Nevertheless, intra-arterial thrombolysis has been shown to improve clinical outcome in selected cases. [ncbi.nlm.nih.gov]

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]

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 and risk factors Basilar artery is the artery most often affected with atherosclerosis of all the intracranial arteries [ 1 ]. [omicsonline.org]

Epidemiology Occurrence in the United States The frequency, incidence, and prevalence of basilar artery occlusion are not known. [emedicine.medscape.com]

Epidemiology, Risk Factors, Clinical Features and Treatment. In Pathology and Genetics: Cerebrovascular Diseases. (Ed. Kalimo H). ISN Neuropath Press, Basel, 2005, pp Roine RO and Kaste M. Published guidelines: update and synthesis. [docplayer.net]

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, Diagnosis and Management. Sixth Edition. Elsevier, Philadelphia, Kaste M and Roine RO. General stroke management and stroke units. In: Mohr JP, Choi, Grotta J, Weir, Wolf, eds. Stroke. Pathophysiology, Diagnosis and Management. [docplayer.net]

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]

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]

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