Here you can read posts from all over the web from people who wrote about basilar artery thrombosis and coma, and check the relations between basilar artery thrombosis and coma. In a patient admitted with a very low gcs requiring inbutation with no other reasonable clinical cause consider basilar artery thrombosis. However, the advent of highquality, reliable, and noninvasive technology. Occlusion and stenosis of basilar artery without mention of cerebral infarction short description. Basilar artery thrombosis may present in three general constellations. Prodromal symptoms that may include headache, neck pain, loss of vision, binocular diplopia, dysarthria, dizziness, hemiparesis, paresthesias. We performed the autopsy and the microscopic examination of the brain stem structures from an individual, whose sudden death raised logical suspicions regarding the causative factor. Thrombosis in a giant basilar trunk fusiform aneurysm. Pdf basilar artery occlusion is a potentially lifethreatening subset of the larger category of. Recanalization of the basilar artery is key to the successful treatment of basilar artery thrombosis and to improving its prognosis. Outcome in patients with basilar artery occlusion treated. Although these may occur anywhere, each of these have predilections for different segments of the basilar artery. Basilar artery thrombosis clinical meet linkedin slideshare. The use of noninvasive imaging such as magnetic resonance imaging and.
Therapy of basilar artery occlusion stroke aha journals. Nov 20, 2012 aim little is known about basilar artery stroke bas in children. The mortality has been estimated as high as 90% without acute intervention. Over the last two decades intravenous thrombolysis has been established as standard treatment for acute thrombotic occlusions of intracranial vessels 3, 4. Randomised trials have shown the safety and efficacy of intravenous thrombolysis ivt given within 4. Some unresolved issues need further clarification, such as the best method of recanalization intraarterial thrombolysis, mechanical thrombolysis, or a combination, the time window for the treatment, and patient. Aortic arch anatomy will determine what catheter shape is best to directly access the appropriate artery with a sheath or whether an alternative access is necessary, such. The basilar artery international cooperation study basics. Rapid onset of advanced motor and bulbar symptoms with a decreased. Basilar artery occlusion in adults is a devastating event, with a mortality rate of 8392%5. Thrombosis from ancient greek thrombosis clotting is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system.
Should we treat aneurysms in perforator arteries from the. Acute basilar thrombosis is known to be a lifethreatening disease for which fatal outcome rates of up to 90% have been reported 1, 2. Vertigo is one of several common presenting symptoms associated with basilar artery occlusion. This is the manifestation of upper brainstem and diencephalic ischemia caused by occlusion of the rostral basilar artery, usually by an embolus. Results the ct attenuation values of the basilar artery on the plain and contrastenhanced scans in the 11 cases of occlusion are given in table 1. Autopsy was obtained in 1 case and confirmed the diagnosis of basilar artery thrombosis. If you continue browsing the site, you agree to the use of cookies on this website. It is present in only 2% cases of stroke in one stroke registry. A cta of the head and neck is performed on every patient with suspected lvo to document the presence or absence of an emergent lvo elvo. Basilar artery occlusion bao is a devastating form of stroke that carries a high rate of mortality and severe disability, especially if recanalization does not occur. Occlusion and stenosis of basilar artery without mention. Acute basilar artery occlusion bao is associated with a very poor outcome and has the highest mortality rate among intracranial largevessel occlusions 1,2.
Superior cerebellar artery sca perforator aneurysms are extremely rare, with only one other case published in the literature. Basilar artery thrombosis statpearls ncbi bookshelf. Clinical presentation and angiographic comparison of 2 cases of basilar artery occlusion seen at the university hospital within 1 week of each other meant to illustrate similarities and differences of etiology, symptoms at onset, and outcomes. Endovascular revascularization for basilar artery occlusion. A third clinical type of presentation is characterized by transient prodromal. Stroke mechanisms and outcomes of isolated symptomatic basilar. Treating basilar artery occlusion nejm journal watch. In literature, we found 3 cases of basilar artery occlusion presenting as seizure without cortical involvement. They can cause headtotoe paralysis called lockedin syndrome. Among the most feared and devastating strokes are ones caused by blockages in the brains critical basilar artery system. Basilar artery occlusion presenting as refractory status epilepticus. Basilar artery occlusion is a potentially lifethreatening subset of the larger category of posterior circulation strokes, carrying 80% fatality rate without treatment.
Background and purpose basilar artery occlusion bao is an infrequent form of. Basilar thrombosis is a potentially fatal event, whose traumatic etiology has been repeatedly stated. Basilar artery stroke in childhood goeggel simonetti. Jan 11, 2019 acute basilar artery thrombosis is associated with a poor prognosis. Magnetic resonance imaging and angiography of brain revealed basilar artery occlusion with infarcts of midbrain, bilateral thalami and cerebellum without. Dec 07, 20 my case presentation on basilar artery thrombosis slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. While diagnosis of basilar thrombosis can be challenging on clinical presentation alone. Arteries are blood vessels that carry blood from the heart to the rest of the body and the heart muscle. However, the advent of highquality, reliable, and noninvasive technology eg, magnetic resonance imaging mri has made its diagnosis possible even in subjects with mild symptoms see the image below. Basilar artery thrombosis may be preceded by transient ischemic attacks tias for days or weeks prior. Despite recent advances in acute stroke treatment, basilar artery occlusion bao is associated with a death or disability rate of close to 70%. If there is an lvo involving the vertebrobasilar system, we perform an immediate mri of the brain to assess brainstemthalamic infarct volume. Background and purpose in acute stroke patients, the presence of a hyperdense middle cerebral artery sign on unenhanced ct is a specific but insensitive indicator of acute thrombosis. In patients with basilar artery occlusion, the mortality rate approaches 100%.
Basilar trunk aneurysms cause pontine infarction because of occlusion of the pontine perforators by fresh thrombus that forms within an aneurysm. Basilar artery occlusion is assumed to carry a grave prognosis, with mortality rates of up to 90%. The clinical presentation of vertebral artery thrombosis significantly depends on the location of occlusion 1 2 3. The objective of this study was to calculate the incidence of bas in children and to analyse the clinical presentation, risk fact. The outcome and mortality associated with bao are worse than those associated with anterior circulation stroke. Acute occlusion of the basilar artery may cause brainstem or thalamic ischemia or infarction.
Acute occlusion of the basilar artery is a neurological emergency that has a high risk of severe disability and mortality. Liu xc, chen c, shi mc, wang sc 20 revascularisation of vertebrobasilar artery occlusion at the chronic stage. Basilar artery occlusion presenting as refractory status. Bypass surgery for the treatment of dolichoectatic basilar. Mechanical thrombectomy for basilar artery occlusion. Background and purpose while intravenous recombinant tissue plasminogen activator rtpa has been approved for acute stroke therapy within 3 hours, the optimum management of basilar artery occlusion bao is still a matter of debate.
Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Aim of this study was to evaluate whether thrombus length as measured in cta is predictive of success rates of intravenous thrombolysis in acute basilar thrombosis. Fatal basilar thrombosis possibly related to minor cervical. Metcalfe k, subramanian g 2015 basilar artery thrombosis a ticking time bomb. B, the cta image demonstrates a basilar artery without evidence of thrombosis. One patient had preangiographic computed tomographic ct received november 12, 1996. The baseline extent of brain stem damage may also influence the outcome. Clinical and radiological predictors of recanalisation and. Fatal basilar thrombosis possibly related to minor. Prompt recognition may lead to early thrombolytic treatment and may improve survival.
The occlusion of the basilar artery was considered from the forensic experts and the consultant staff as the causative factor of death. Basilar artery occlusion in a teenaged boy treated with intra. Brandt reported that in basilar artery ba thrombosis intraarterial administration of thrombolysis led to recanalization in 51%, but a mortality of 92% among the patients with persistently. A 52yearold man with a history of patent foramen ovale presented with diplopia, a left facial droop, and mild leftside weakness admission nihss of 3. Basilar artery thrombosis with occlusion of a precerebral artery a basilaris thrombosis with occlusion other precerebral artery. The clinical presentation of basilar artery occlusion bao ranges from mild transient symptoms to devastating strokes with high fatality and morbidity. Delayed treatment of basilar thrombosis in a patient with. Tenyear followup of giant basilar aneurysm treated by. The arrow points out a persistent highgrade mid basilar stenosis after recanalization in case 2. This can be a difficult call as often even on routine scans in older patients the basilar artery can app. Basilar artery thrombosis has fairly typical imaging features by both ct and mr.
Wallenberg syndrome is a term denoting ischemia of the lateral medulla arising from the obstruction of the intracranial vertebral artery, manifesting as horners syndrome ptosis, anhydrosis, and miosis, ataxia, dysphagia, and a reduced sensation of temperature and pain on. The pathogenesis of occlusion can be secondary to both local atherothrombosis or cardioembolism. Stroke mechanisms and outcomes of isolated symptomatic. We compared intraarterial thrombolysis with the combined bridging approach of intravenous abciximab and intraarterial thrombolysis with rtpa bridging. Basilar artery stroke in childhood goeggel simonetti 20. Once the stent was deployed, it slid out of place towards the sac thick arrows in d. However, the available data indicate that successful recanalization increases the probability of survival but not necessarily a. Mechanical thrombectomy of acute basilar artery occlusion.
Occlusion of the basilar artery is one of the most devastating forms of ischemic stroke. There is no conclusive management strategy for these aneurysms, although endovascular treatment, open surgical treatment with clipping, and antifibrinolytic administration with spontaneous thrombosis have all been discussed. Intraarterial thrombolysis has shown to be effective in anterior circulation mca vessel. Acute stroke caused by basilar artery occlusion bao has devastating effects on patients. Aneurysm of the basilar artery hollow arrow and evidence of wide neck thin arrows. Finally, the severity of clinical presentation may range from isolated cranial nerve palsies to. Operative treatment of a superior cerebellar artery. Hyperdense basilar artery sign on unenhanced ct predicts. The use of mechanical thrombectomy in the treatment of. Background performing mechanical thrombectomy mt in patients with basilar artery occlusion bao is currently not evidencebased. Longterm outcome after intravenous thrombolysis of. In this case the end organ damage is already apparent. Arterial thrombosis is a blood clot in an artery, which can be very serious because it can stop blood reaching important organs.
The diagnosis may be difficult and need close clinicoradiological correlation. Objective to compare patients outcome, relative merits of achieving recanalization, and predictors of futile recanalization fr between bao and anterior circulation large vessel occlusion aclvo mt. An analysis of clinical symptoms in course of basilar artery thrombosis, with or without an accompanying thrombosis of vertebral arteries, is found in available medical literature. Thrombolytic therapy of acute basilar artery occlusion. A balloonexpandable stent arrowhead in b and thick arrow in c is advanced on a microguidewire thin arrows in b. Seizures are more common with anterior circulation stroke and rare in posterior circulation stroke. Acute basilar artery thrombosis is associated with a poor prognosis. Basilar thrombus and occlusion of the left vertebral artery. While diagnosis of basilar thrombosis can be challenging on clinical presentation alone, computed tomographic angiography cta has shown to be the adequate imaging modality 22, 23.
A, the basilar artery appears hyperdense on unenhanced ct arrowhead. More than 67% of basilar artery occlusion patients present 3 h after symptom onset, which is, in part, a reflection of the illdefined symptoms. Here we present the first case of delayed intraarterial thrombolysis of a basilar artery thrombosis associated with a large saccular. Imaging in acute basilar artery thrombosis university of. Acute basilar artery occlusion radiology reference article. Our purpose was to determine whether the hyperdense basilar artery hdba sign has utility in detecting thrombosis and predicting outcome in patients presenting with signs and symptoms of posterior circulation. Recovery of injured corticospinal tracts after late. Results 87% of patients had no recanalization of basilar artery after.
Endovascular thrombectomy for acute basilar artery. Most data on the outcome of basilar artery occlusion are from recent case series of patients treated with intraarterial thrombolysis. Acute occlusion of the basilar artery can be due to either thromboembolism, atherosclerosis or propagation of intracranial dissection. Imaging in acute basilar artery thrombosis springerlink. The majority of cases are due to thrombosis due to atherosclerotic disease, but can also be secondary to cardioembolic or infectious sources. Delayed thrombolysis or endovascular therapy has been performed with some success in patients who present after 3 hours of symptom onset. Thrombosis of the basilar artery is dangerous because it can have serious consequences and complications that often have a lethal outcome. Even when a blood vessel is not injured, blood clots.
Delayed treatment of basilar thrombosis in a patient with a. In face of lacking other etiological factors that could have explained the impressive thrombotic occlusion of basilar artery, leading to immediate death, the experts concluded that minor cervical trauma could be responsible. Diagnosis is often delayed, or even missed, as a result of the variety of clinical presentations seen with this condition. It carries a high mortality of 8595% if recanalization does not occur, and a substantial part of survivors suffer severe disability, some being in locked in state. Mechanical thrombectomy for basilar artery thrombosis. The use of mechanical thrombectomy in the treatment of basilar artery occlusion case report. The limited knowledge on the outcome after a conventional treatment approach comes from a few small case series of highly selected patients. This condition accounts for about 1% to 4% of all ischemic strokes and is generally related to local atherothrombosis or cardioembolism. Acute basilar artery occlusion radiology reference. Relationship between clot location and outcome after basilar.
All measurements were taken with osirix imaging software. Treating the most feared and devastating strokes sciencedaily. Materials and methods from december 1992 through may 1996, 20 of 22 patients with angiographically confirmed basilar artery thrombosis were treated with intraarterial urokinase. To further our understanding of the best treatment for acute basilar artery occlusion bao, researchers conducted this prospective registry study of patients presenting with severe deficits coma, lockedin syndrome, or quadriplegia or mildtomoderate deficits any basilar artery territory signs other than severe signs. The benefit of recanalization in basilar artery occlusion bao has been established. The clinical presentation of vao varies with the area of ischemia and cause of occlusion. Department of neurology, and neurosciences program, biomedicum helsinki. Since the disease is associated with the formation of a thrombus in the basilar artery, its main danger is that it can come off and clog the vessel completely. Etiologies such as prothrombotic diseases6, anabolic steroid7, inflammatory vasculitis8, spontaneous dissection9, neonatal thromboembolism10, and vertebral artery dissection11. If an elvo is present, the cta also helps preplan the thrombectomy procedure. Recanalization treatments in basilar artery occlusion. When a blood vessel a vein or an artery is injured, the body uses platelets thrombocytes and fibrin to form a blood clot to prevent blood loss.
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