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. 2003 Dec;74(12):1621–1626. doi: 10.1136/jnnp.74.12.1621

Heralding manifestations of basilar artery occlusion with lethal or severe stroke

G von Campe 1, F Regli 1, J Bogousslavsky 1
PMCID: PMC1757423  PMID: 14638878

Abstract

Background: Basilar artery occlusion usually causes severe disability or death. Until the recent developments in local intra-arterial or systemic intravenous fibrinolysis, interest in early diagnosis was low because there was no satisfactory treatment. Thus there is little information about the initial phase of the disease.

Objective: To report on the early clinical features and patterns of evolution of severe symptomatic basilar artery occlusion.

Methods: 24 patients with established basilar artery occlusion (confirmed by angiography or at necropsy) were reviewed retrospectively, focusing on the early clinical aspects and time course of the disease.

Results: The most common initial symptoms were motor deficits (16/24, including facial palsies), articulatory speech difficulties (15/24), vertigo, nausea or vomiting (13/24), and headaches (10/24). The most frequent objective initial findings were motor deficits (22/24), facial palsies (19/24), eye movement abnormalities (15/24), lower cranial nerve deficits (15/24), altered level of consciousness (12/24), and bilateral extensor plantar responses (9/24). Onset of the disease was gradual in nearly all patients and in half the warning signs were present for up to two months before the final stage. Headaches and visual disturbances were early signs, while speech difficulties and motor deficits were late signs. Once permanent neurological deficits were present, the final illness was reached within six hours in 41%, between six and 24 hours in 32%, and in two to three days in 27%.

Conclusions: All the patients reviewed presented some symptoms and signs pointing to brain stem involvement. Only 8% (2/24) had an acute course with no adequate warning signs.

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Selected References

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  1. Al-Wardi D. A., Adams A. H., Hamilton A. E. Four cases of "locked-in" syndrome and review of the literature. Bull Los Angeles Neurol Soc. 1975 Apr;40(2):60–70. [PubMed] [Google Scholar]
  2. Archer C. R., Horenstein S. Basilar artery occlusion: clinical and radiological correlation. Stroke. 1977 May-Jun;8(3):383–390. doi: 10.1161/01.str.8.3.383. [DOI] [PubMed] [Google Scholar]
  3. BIEMOND A. Thrombosis of the basilar artery and the vascularization of the brain stem. Brain. 1951 Sep;74(3):300–317. doi: 10.1093/brain/74.3.300. [DOI] [PubMed] [Google Scholar]
  4. Berg-Dammer E., Felber S. R., Henkes H., Nahser H. C., Kühne D. Long-term outcome after local intra-arterial fibrinolysis of basilar artery thrombosis. Cerebrovasc Dis. 2000 May-Jun;10(3):183–188. doi: 10.1159/000016054. [DOI] [PubMed] [Google Scholar]
  5. Berlit P. Isolierter Schwindel bei vertebrobasilärer Ischämie--gibt es das? HNO. 1998 Apr;46(4):296–300. doi: 10.1007/s001060050244. [DOI] [PubMed] [Google Scholar]
  6. Bogousslavsky J., Regli F., Maeder P., Meuli R., Nader J. The etiology of posterior circulation infarcts: a prospective study using magnetic resonance imaging and magnetic resonance angiography. Neurology. 1993 Aug;43(8):1528–1533. doi: 10.1212/wnl.43.8.1528. [DOI] [PubMed] [Google Scholar]
  7. Caplan L. R. Occlusion of the vertebral or basilar artery. Follow up analysis of some patients with benign outcome. Stroke. 1979 May-Jun;10(3):277–282. doi: 10.1161/01.str.10.3.277. [DOI] [PubMed] [Google Scholar]
  8. Cossa P., Boucebci M., Darcourt G. Un nouveau cas de thrombose complète du tronc basilaire avec récupération partielle et survie actuelle de près de deux ans. Rev Neurol (Paris) 1965 Dec;113(6):635–636. [PubMed] [Google Scholar]
  9. FREEMAN I., ELLIS W. R., Jr, KNOX L. J. Occlusion of the basilar artery; an unusual case with recovery. Neurology. 1953 Feb;3(2):154–156. doi: 10.1212/wnl.3.2.154. [DOI] [PubMed] [Google Scholar]
  10. Ferbert A., Brückmann H., Drummen R. Clinical features of proven basilar artery occlusion. Stroke. 1990 Aug;21(8):1135–1142. doi: 10.1161/01.str.21.8.1135. [DOI] [PubMed] [Google Scholar]
  11. Fisher C. M. The 'herald hemiparesis' of basilar artery occlusion. Arch Neurol. 1988 Dec;45(12):1301–1303. doi: 10.1001/archneur.1988.00520360019004. [DOI] [PubMed] [Google Scholar]
  12. GAUTHIER G. [Contribution to the study of basilar thrombosis]. Schweiz Arch Neurol Neurochir Psychiatr. 1962;90:209–contd. [PubMed] [Google Scholar]
  13. Grond M., Rudolf J., Schmülling S., Stenzel C., Neveling M., Heiss W. D. Early intravenous thrombolysis with recombinant tissue-type plasminogen activator in vertebrobasilar ischemic stroke. Arch Neurol. 1998 Apr;55(4):466–469. doi: 10.1001/archneur.55.4.466. [DOI] [PubMed] [Google Scholar]
  14. HAUGSTED H. Occlusion of the basilar artery; diagnosis by vertebral angiography during life. Neurology. 1956 Nov;6(11):823–828. doi: 10.1212/wnl.6.11.823. [DOI] [PubMed] [Google Scholar]
  15. Hacke W., Zeumer H., Ferbert A., Brückmann H., del Zoppo G. J. Intra-arterial thrombolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke. 1988 Oct;19(10):1216–1222. doi: 10.1161/01.str.19.10.1216. [DOI] [PubMed] [Google Scholar]
  16. Henze T., Boeer A., Tebbe U., Romatowski J. Lysis of basilar artery occlusion with tissue plasminogen activator. Lancet. 1987 Dec 12;2(8572):1391–1391. doi: 10.1016/s0140-6736(87)91275-x. [DOI] [PubMed] [Google Scholar]
  17. Herderscheê D., Limburg M., Hijdra A., Koster P. A. Recombinant tissue plasminogen activator in two patients with basilar artery occlusion. J Neurol Neurosurg Psychiatry. 1991 Jan;54(1):71–73. doi: 10.1136/jnnp.54.1.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Huber M., Hojer C., Schröder R. Klinische und pathologisch-anatomische Befunde bei akuten Basilaristhrombosen. Eine Untersuchung an 30 autoptisch gesicherten Fällen. Nervenarzt. 1990 Feb;61(2):83–87. [PubMed] [Google Scholar]
  19. Kamps I., Weiss J., Ringelstein E. B. Repetitive Behandlung einer subtotalen vertebrobasilären Stenose mit "tissue plasminogen activator" (tPA). Nervenarzt. 1992 Dec;63(12):755–760. [PubMed] [Google Scholar]
  20. Knepper L., Biller J., Adams H. P., Jr, Yuh W., Ryals T., Godersky J. MR imaging of basilar artery occlusion. J Comput Assist Tomogr. 1990 Jan-Feb;14(1):32–35. doi: 10.1097/00004728-199001000-00005. [DOI] [PubMed] [Google Scholar]
  21. Labauge R., Pages M., Marty-Double C., Blard J. M., Boukobza M., Salvaing P. Occlusion du tronc basilaire. Rev Neurol (Paris) 1981;137(10):545–571. [PubMed] [Google Scholar]
  22. Labauge R., Pagès M., Blard J. M. Survie prolongée après occlusion du tronc basilaire. 4 cas. Rev Neurol (Paris) 1989;145(11):789–794. [PubMed] [Google Scholar]
  23. Liu J., Tuhrim S., Weinberger J., Song S. K., Anderson P. J. Premonitory symptoms of stroke in evolution to the locked-in state. J Neurol Neurosurg Psychiatry. 1983 Mar;46(3):221–226. doi: 10.1136/jnnp.46.3.221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Maeder P., Meuli R., Gudinchet F., Bogousslavsky J. Angiographie par résonance magnétique (ARM) dans les accidents ischémiques vertébro-basilaires. Praxis (Bern 1994) 1996 Feb 27;85(9):272–277. [PubMed] [Google Scholar]
  25. Obrador S., Reinoso-Suarez F., Carbonell J., Martinez-Moreno E., Navarro H., Oliva H., Oliveros J. C., Cordoba A. Comatose state maintained during eight years following a vascular ponto-mesencephalic lesion. Electroencephalogr Clin Neurophysiol. 1975 Jan;38(1):21–26. doi: 10.1016/0013-4694(75)90206-0. [DOI] [PubMed] [Google Scholar]
  26. Patterson J. R., Grabois M. Locked-in syndrome: a review of 139 cases. Stroke. 1986 Jul-Aug;17(4):758–764. doi: 10.1161/01.str.17.4.758. [DOI] [PubMed] [Google Scholar]
  27. Ropper A. H. 'Convulsions' in basilar artery occlusion. Neurology. 1988 Sep;38(9):1500–1501. doi: 10.1212/wnl.38.9.1500-a. [DOI] [PubMed] [Google Scholar]
  28. Ruggieri P. M., Masaryk T. J., Ross J. S. Magnetic resonance angiography. Cerebrovascular applications. Stroke. 1992 May;23(5):774–780. doi: 10.1161/01.str.23.5.774. [DOI] [PubMed] [Google Scholar]
  29. SIEKERT R. G., MILLIKAN C. H. Studies in cerebrovascular disease. II. Some clinical aspects of thrombosis of the basilar artery. Proc Staff Meet Mayo Clin. 1955 Mar 9;30(5):93–100. [PubMed] [Google Scholar]
  30. Schwaighofer B. W., Klein M. V., Lyden P. D., Hesselink J. R. MR imaging of vertebrobasilar vascular disease. J Comput Assist Tomogr. 1990 Nov-Dec;14(6):895–904. doi: 10.1097/00004728-199011000-00005. [DOI] [PubMed] [Google Scholar]
  31. Stock K. W., Radue E. W., Jacob A. L., Bao X. S., Steinbrich W. Intracranial arteries: prospective blinded comparative study of MR angiography and DSA in 50 patients. Radiology. 1995 May;195(2):451–456. doi: 10.1148/radiology.195.2.7724765. [DOI] [PubMed] [Google Scholar]
  32. Tsakiris D. A., Stock K. W., Mürner J., Radü E. W., Mäder G., Marbet G. A. Lokale therapeutische Fibrinolyse bei ischämischen zerebrovaskulären Insulten: erste Ergebnisse bei 6 Patienten. Schweiz Med Wochenschr. 1993 Sep 25;123(38):1784–1789. [PubMed] [Google Scholar]
  33. Wentz K. U., Röther J., Schwartz A., Gückel F., Rautenberg W., Jaschke W., Mattle H. P., Suchalla R., Georgi M. MR-Angiographie des vertebrobasilären Stromgebiets: Einsatzmöglichkeiten der Saturationstechnik zur Bestimmung der Flussrichtung. Rofo. 1992 Feb;156(2):120–124. doi: 10.1055/s-2008-1032849. [DOI] [PubMed] [Google Scholar]
  34. Wijdicks E. F., Nichols D. A., Thielen K. R., Fulgham J. R., Brown R. D., Jr, Meissner I., Meyer F. B., Piepgras D. G. Intra-arterial thrombolysis in acute basilar artery thromboembolism: the initial Mayo Clinic experience. Mayo Clin Proc. 1997 Nov;72(11):1005–1013. doi: 10.4065/72.11.1005. [DOI] [PubMed] [Google Scholar]
  35. Wildemann B., Hutschenreuter M., Krieger D., Hacke W., von Kummer R. Infusion of recombinant tissue plasminogen activator for treatment of basilar artery occlusion. Stroke. 1990 Oct;21(10):1513–1514. doi: 10.1161/01.str.21.10.1513. [DOI] [PubMed] [Google Scholar]
  36. Willig V., Steiner T., Hacke W. Thrombolytische Therapie beim ischämischen Insult. Wien Klin Wochenschr. 1997 Oct 31;109(20):795–803. [PubMed] [Google Scholar]
  37. Zeumer H., Freitag H. J., Grzyska U., Neunzig H. P. Local intraarterial fibrinolysis in acute vertebrobasilar occlusion. Technical developments and recent results. Neuroradiology. 1989;31(4):336–340. doi: 10.1007/BF00344178. [DOI] [PubMed] [Google Scholar]
  38. Zeumer H., Hacke W., Kolmann H. L., Poeck K. Lokale Fibrinolysetherapie bei Basilaris-Thrombose. Dtsch Med Wochenschr. 1982 May 14;107(19):728–731. doi: 10.1055/s-2008-1070010. [DOI] [PubMed] [Google Scholar]
  39. Zeumer H. Vascular recanalizing techniques in interventional neuroradiology. J Neurol. 1985;231(6):287–294. doi: 10.1007/BF00313704. [DOI] [PubMed] [Google Scholar]
  40. von Romatowski H. J., Henze T., Tebbe U. Rekanalisation eines Verschlusses der A. basilaris mit Gewebe-Plasminogen-Aktivator. Dtsch Med Wochenschr. 1988 Apr 15;113(15):616–616. [PubMed] [Google Scholar]

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