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Basilar Artery Thrombosis


Presentation

  • Despite severe stroke at presentation, good functional recovery at 3 months (modified Rankin scale [mRS] 1) occurred in 2 patients; mRS 4 in 1, and 2 died.[ncbi.nlm.nih.gov]
  • Clinical presentation varies depending on the location of the occlusion. The symptoms include mild dysarthria to coma or sudden death. The initial subtle clinical presentation could lead to misdiagnosis.[ncbi.nlm.nih.gov]
  • A 40-year-old man presented to an emergency department with slurred speech, diplopia and agitation several hours after cocaine use. His level of consciousness rapidly dropped in the hours following presentation.[ncbi.nlm.nih.gov]
  • It leads to brain stem ischemia and commonly presents with impaired consciousness, cranial nerve palsy, hemiplegia or quadriplegia, and sudden collapse.[ncbi.nlm.nih.gov]
  • Multiple cranial nerve palsies and hemiparesis were the most common clinical symptoms at presentation. CT revealed hyperdense basilar arteries (n 7) and hypodensities in the posterior circulation territory (n 8).[ncbi.nlm.nih.gov]
Candidiasis
  • Intraventricular fungus ball: a unique manifestation of refractory intracranial candidiasis in an immunocompetent neonate . Journal of Neurosurgery: Pediatrics, p. 584. CrossRef Google Scholar Elbers, Jorina and Benseler, Susanne M 2008.[cambridge.org]
Decreased Sweating
  • Nystagmus, diplopia, oscillopsia, vertigo, nausea, vomiting Vestibular nucleus Horner’s syndrome (miosis, ptosis, decreased sweating) Descending sympathetic tract Dysphagia, hoarseness, paralysis of palate, paralysis of vocal cord, diminished gag reflex[minclinic.ru]
Facial Numbness
  • Transient dizziness in conjunction with double vision before his eyes (diplopia), speech disorder (dysarthria), facial numbness or perioral area and sensitivity disorders than half of the body indicates a transient cerebrovascular insufficiency (TIA)[minclinic.ru]
Distractibility
  • Open reduction was achieved with exposure of the C-4 and C-5 bodies and sequential distraction. After anatomical alignment was achieved, an interbody graft was placed and a cervical plate secured.[ncbi.nlm.nih.gov]
Truncal Ataxia
  • Thirty-six hours after sustaining a head injury in the occipital region, a young man developed vomiting, headache, dizziness and truncal ataxia, without signs of focal impairment.[ncbi.nlm.nih.gov]
Long Tract Signs
  • Basilar artery syndrome (the syndrome of the lone vertebral artery is equivalent) A combination of the various brainstem syndromes plus those arising in the posterior cerebral artery distribution Bilateral long tract signs (sensory and motor; cerebellar[minclinic.ru]
Oscillopsia
  • Nystagmus, diplopia, oscillopsia, vertigo, nausea, vomiting Vestibular nucleus Horner’s syndrome (miosis, ptosis, decreased sweating) Descending sympathetic tract Dysphagia, hoarseness, paralysis of palate, paralysis of vocal cord, diminished gag reflex[minclinic.ru]
Motor Symptoms
  • Confirmation of the diagnosis are a combination of bilateral symptoms of long wires (sensory and motor), symptoms of cranial nerves, cerebellar dysfunction.[minclinic.ru]

Workup

  • A head CT was recommended for her headache, but she refused further workup. A presumptive diagnosis of sinusitis was made and she was treated with amoxicillin and ciprofloxacin/dexamethasone otic suspension and discharged home.[westjem.com]
  • We would give this patient the benefit of the doubt and initiate a full stroke workup that includes noncontrast CT, CTA, and CT perfusion. It is imperative to identify the site of underlying vascular occlusion before proceeding further. Figure 1 Dr.[evtoday.com]

Treatment

  • Combined fibrinolytic agents and glycoprotein IIb/IIIa inhibitors may have high potential in the treatment of acute cerebrovascular thrombosis.[ncbi.nlm.nih.gov]
  • The aim of our study was to review our experience with computed tomography angiography (CTA) in the diagnosis of basilar artery thrombosis and its treatment with endovascular procedures.[ncbi.nlm.nih.gov]
  • At the time of treatment, 6 patients were somnolent and 14 comatose, and tetraparesis was present in 15. The time between the onset of symptoms and treatment ranged from 1 to 48 h. The mortality rate was 35% (7/20 patients).[ncbi.nlm.nih.gov]
  • Basilar artery thrombosis is an infrequent but important neurological emergency requiring early diagnosis and treatment.[ncbi.nlm.nih.gov]
  • However, because neither randomized clinical trials nor observational data provide evidence for treatment efficacy and there are substantial risks and costs associated with this procedure, this treatment should only be performed in the context of a randomized[ncbi.nlm.nih.gov]

Prognosis

  • Basilar artery thrombosis has a very poor prognosis. A 56-year-old comatose man with acute basilar artery occlusion was successfully treated with local urokinase infusion which reopened the basilar artery and revealed a midbasilar stenotic plaque.[ncbi.nlm.nih.gov]
  • Thrombotic disease of the vertebrobasilar circulation is associated with a poor prognosis. It may occur in trauma patients, especially those with neck injuries and even several months after the initial insult.[ncbi.nlm.nih.gov]
  • MRI shows acute ischemia pons with no bleed, with MRA showing lack of flow signal of midthird basilar, possibly due to atheromatous thrombosis with Brainstem DWI score of 6 suggesting moderate prognosis.[sumerdoc.blogspot.com]
  • Louis, MO 63110, USA. wjp@npg.wustl.edu Abstract The poor prognosis for recovery of basilar artery thrombosis has led to the adoption at many institutions of intra-arterial thrombolysis as part of clinical care.[ncbi.nlm.nih.gov]
  • Author(s) De Decker K, Van Havenbergh T, D'Archambeau O, Jorens PG Abstract Thrombotic disease of the vertebrobasilar circulation is associated with a poor prognosis.[neus-keel-oor.be]

Etiology

  • Tong Q (1919) Pathological and etiological studies on cerebral infarction in the vertebrobasilar arterial system. Chin J Neurol Psychiatry 14:149–151 Google Scholar 6.[link.springer.com]
  • 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]
  • The final etiological diagnosis of BAO was established in 16/102 (16%) of all cases.[journals.plos.org]
  • Dominant etiologic factors such as local thrombosis or artery-to-artery thromboembolism originating from arteriosclerotic lesions account for 50% of BAOs. 2,3 Other major etiologies are cardiac emboli and vertebral artery dissections.[stroke.ahajournals.org]

Epidemiology

  • Epidemiology A relatively uncommon form of stroke.[patient.info]
  • Epidemiology and risk factors Basilar artery is the artery most often affected with atherosclerosis of all the intracranial arteries [ 1 ].[omicsonline.org]
Sex distribution
Age distribution

Pathophysiology

  • 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]
  • A traditional recanalization approach based on historical controls and pathophysiological consideration is local intra-arterial thrombolysis (IAT) in eligible patients.[ahajournals.org]
  • Pathophysiology Atherosclerosis : the most common vascular disease affecting the vertebrobasilar system: [ 1 ] This affects large vessels, causing narrowing and occlusion.[patient.info]
  • In Barnet HJM (and others, Eds), Stroke: Pathophysiology, Diagnosis and Management. New York: Chrchill-Livingstone, pp 549-619, 1986 Dai, A. I. and M. Wasay (2006). "Wernekink comissure syndrome: a rare midbrain syndrome secondary to stroke."[dizziness-and-balance.com]

Prevention

  • Because angiography requires the injection of contrast into the artery, this procedure is fraught with potential risk and can lead to stroke, which should be prevented.[minclinic.ru]
  • CGRP inhibitors are a new class of preventive medicine that your doctor may recommend if other medicines don’t help.[webmd.com]
  • Even with vertebral artery occlusion, collaterals (circle of Willis) may prevent ischaemia.[patient.info]
  • The preventive or curative endovascular treatment of embolism to the distal vascular network must be achieved at the same time as the treatment of the primary lesion. Vertebro-basilar strokes can be prevented by two different techniques.[em-consulte.com]
  • A thrombosis, or blood clot, may block the artery and prevent blood from passing through.[healthline.com]

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