Tuesday 7 June 2011

Basilar Artery Thrombosis

Basilar Artery Thrombosis General Details:
  • Thrombotic basilar artery occlusion.
  • Reported in 2 per 1000 autopsy cases.
  • Stroke registries ~ 27% of ischemic strokes occurring in the posterior circulation.
Basilar Artery Thrombosis Clinical Features:
  • Coma / decreased consciousness
  • Headache
  • Locked-in syndrome
  • Ocular palsies
  • Photopsia - occipital lobe ischaemia)
  • Pseudobulbar palsy
  • Pupillary palsies
  • Quadriparesis
  • Vertigo
  • Visual disturbance
  • Visual loss - occipital lobe ischaemia
Basilar Artery Thrombosis Aetiology:
  • Atherosclerotic occlusive disease - esp. mid segment of the basilar artery, followed by the vertebrobasilar junction.
  • Embolism - more frequent in the distal 1/3rd of the basilar artery & vertebrobasilar junction.
  • Arterial dissection - more common in the extracranial vertebral artery; intracranial dissections very uncommon.
Basilar Artery Thrombosis Investigations:
  • MRI or CT angiogram - basilar artery occlusion, either in the proximal portion (top of the basilar syndrome, usually with midbrain and thalamic damage) or more extensively.
Basilar Artery Thrombosis Treatment:
  • Thrombolysis - early presentations; with intravenous or intra-arterial recombinant thromboplastin activator (rTPA). 
  • Thrombolysis can reverse the ischaemic damage noted, which is often fatal if untreated.
Basilar Artery Thrombosis Prognosis:
  • Generally poor prognosis.
  • However, some patients may have a limited ischaemic injury associated with an acute partial occlusion or a slow progressive occlusion.
Image: Basilar Artery Thrombosis on CT showing dense basilar artery; thrombolysis catheter and angiogram showing filling defect (Radpod Picture of the Day) (cc)
Tags: Arterial Dissection - Basilar Artery Thrombosis - Embolism - rTPA - Thrombolysis - TPA
Posted by Medicalchemy
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