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At least 37 records · Page 2Linked to original sources
PubMed1999

Basilar artery occlusion due to spontaneous basilar artery dissection in a child.

Basilar artery occlusion (BAO) causing brainstem infarction occurred in a 7-year-old boy without any basic disorders. A diagnosis of BAO due to basilar artery dissection (BAD) was suspected at angiography, and this was confirmed by gadolinium-enhanced magnetic resonance imaging (MRI). These investigations clearly showed all the typical diagnostic signs such as a pseudolumen, double lumen and intimal flap, and a pseudolumen in resolution. The spontaneous healing of the dissection was clearly demonstrated during 10 months of follow-up. We stress that BAD can occur in young children and that combined diagnosis with gadolinium-enhanced MRI and angiography is conclusive for diagnosis of dissecting aneurysms. Wider use of these combined diagnostic methods will allow the detection of less severe basilar artery dissection, thus extending the spectrum of presentation and prognosis.

Aortic Dissection↗
PubMedDate not supplied

Effect of simvastatin given alone and in combination with valsartan or enalapril on blood pressure and the structure of mesenteric resistance arteries and the basilar artery in the genetically hypertensive rat model.

1. The aims of the present study were to investigate, in the New Zealand genetically hypertensive (GH) rat model, the effects of treatment with simvastatin, alone or in combination with valsartan or enalapril, on blood pressure (BP) and structural remodelling of mesenteric resistance arteries (MRA) and of the basilar artery, an artery that plays a major role in the regulation of cerebral resistance. 2. Genetically hypertensive rats were treated with simvastatin at two dose levels (5 and 10 mg/kg per day) and simvastatin in combination with valsartan or enalapril (also 5 and 10 mg/kg per day) from the age of 7 to 12 weeks. Systolic BP and bodyweight were measured weekly. 3. At the end of the experiment, following fixation by perfusion, MRA and the basilar artery were excised and embedded in Technovit (a glycol methacrylate medium; Heraeus Kulzer, Werheim, Germany). Serial sections were cut and stereological techniques used to determine tunica media width and cross-sectional area (CSA), lumen diameter and the ratio of media width/lumen diameter. 4. Simvastatin monotherapy did not lower BP at either dose. In the high- and low-dose groups, the combination of simvastatin + enalapril lowered BP more than with enalapril alone; this was also true for the simvastatin + valsartan combination in the lower-dose group. 5. The MRA were hypotrophically remodelled by the 10 mg/kg per day dose of simvastatin; the 5 mg/kg per day dose caused hypotrophic remodelling with decreased media/lumen ratio. Valsartan and enalapril caused hypotrophic remodelling together with outward remodelling of the lumen in the 10 mg/kg per day valsartan group and, in all groups, a reduction in the media/lumen ratio, with the greatest effect observed in the high-dose groups. 6. The combination treatments of simvastatin + valsartan and simvastatin + enalapril did not have any consistent extra effect on MRA remodelling. 7. In the basilar artery, high-dose simvastatin had a hypotrophic effect on the media and both doses reduced the media/lumen ratio independently of any change in BP. 8. Simvastatin given in combination with valsartan produced a slight further reduction in medial CSA, media width and ratio. In combination with enalapril, there was little consistent additional effect. 9. Simvastatin monotherapy hypotrophically remodelled the media of the basilar artery in the GH rat model, even in the absence of changes in BP. A similar structural effect may explain, in part, the reduction in stroke seen in patients treated with statins.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

[A ruptured aneurysm of the distal posterior inferior cerebellar artery associated with basilar artery occlusion: a case report].

We presented a case of a distal posterior inferior cerebellar artery (PICA) aneurysm associated with basilar artery occlusion. A 66-year-old female was found unconscious at home and transferred to our hospital in a deep coma on February 9, 1991. Emergency CT scan revealed subarachnoid hemorrhage in the posterior fossa. She was treated conservatively because of her poor neurological status. The angiograms performed on February 13 showed occlusion of the basilar artery and a saccular aneurysm at the cortical branch of the PICA. The contrast material remained in the aneurysm for a long time throughout the venous phase. The left vertebral artery was markedly hypoplastic. The patient improved remarkably after admission and became almost alert late in February, although she still presented tetraparesis, dysfunction of lower cranial nerves and other neurological signs linked with the brain stem. The unusual angiographical findings in this case prompted us to perform the examination again, expecting some angiographical changes. The angiograms taken on March 15 revealed spontaneous disappearance of the aneurysm, although the basilar artery occlusion remained unchanged. The authors discussed some problems involved in this case, including the relation between the aneurysm and the arterial occlusion, and the mechanism of spontaneous disappearance of the aneurysm.

Aged↗
PubMed1994

Basilar artery occlusion caused by thrombosis of atherosclerotic fusiform aneurysm of the basilar artery.

BACKGROUND: Basilar artery occlusion caused by thrombosis of atherosclerotic fusiform aneurysm of the basilar artery is rare. We present a case confirmed by 6 years of follow-up and autopsy. CASE DESCRIPTION: A 63-year-old man suffered from brain stem infarction. Computed tomography and angiography showed a fusiform aneurysm on the proximal portion of the basilar artery. At the time of the third attack 5 years later, complete thrombosis of the aneurysm was found, and the proximal basilar artery was occluded. On autopsy, an atherosclerotic aneurysm 15 mm in diameter was found. CONCLUSIONS: A large atherosclerotic fusiform aneurysm of the basilar artery often causes brain stem infarction and involves a risk of complete thrombosis of the aneurysm and subsequent parent artery occlusion.

Aged↗
PubMed2003

Basilar artery occlusion in children: misleading presentations, "locked-in" state, and diagnostic importance of accompanying vertebral artery occlusion.

Basilar artery occlusion in children is rare. The clinical diagnosis of basilar artery occlusion is often difficult because the initial neurologic findings, most frequently hemiparesis, involuntary movements, or headache, are often transient and can suggest complicated migraine, seizures, or both. We have reviewed 37 previously reported pediatric cases of basilar artery occlusion and present 3 additional ones. In the 40 cases, basilar artery occlusion alone occurred in 22; in the other 18, there was accompanying vertebral artery occlusion. 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. The cause was found much more often in cases of basilar artery occlusion with accompanying vertebral artery occlusion, with trauma being the most frequent etiology, especially in boys between 6 and 14 years. Of the 37 previously reported pediatric cases of basilar artery occlusion, 7 were "locked in" early in the course (mute, quadriparetic, aware, and communicative with eye movements), as were our 3 cases. In most cases of basilar artery occlusion that are locked in, the basilar artery occlusion involves its midportion, sparing the anterior inferior cerebellar and superior cerebellar arteries.

Adolescent↗
PubMed2004

Therapeutic basilar artery occlusion for management of medically refractory basilar artery stenosis: case report.

OBJECTIVE AND IMPORTANCE: To describe a novel therapeutic approach (endovascular basilar artery occlusion) to a notoriously difficult-to-manage clinical condition (actively symptomatic high-grade basilar artery stenosis) on the basis of assessment of the patient-specific mechanism of disease. CLINICAL PRESENTATION: An 81-year-old woman presented with recurrent episodes of brainstem ischemia refractory to aggressive medical therapy. Cerebral angiography revealed a high-grade proximal basilar artery stenosis. On the basis of clinical presentation and angiographic findings, the pathogenesis of this complex of symptoms was thought to be embolic rather than hemodynamic. INTERVENTION: Endovascular coil occlusion of the basilar artery was used, with excellent outcome (cessation of ischemic symptoms and independent level of functioning at 1 yr). CONCLUSION: Successful endovascular management of intracranial occlusive disease requires understanding of the mechanism responsible for the patient's symptoms.

Aged↗
PubMed1997

Intra-arterial thrombolysis in acute basilar artery thromboembolism: the initial Mayo Clinic experience.

OBJECTIVE: To investigate the feasibility of intra-arterial thrombolysis in acute basilar artery thrombosis. DESIGN: We reviewed a consecutive series of patients in whom intra-arterial thrombolysis was performed during the period from 1994 to 1996. MATERIAL AND METHODS: Intra-arterial thrombolysis with urokinase was done in an attempt to recanalize the basilar artery in a series of nine patients with basilar artery thrombosis admitted to the neurologic intensive care unit. At the time of initial assessment, all nine patients had major neurologic deficits attributable to brain-stem ischemia, including two patients with locked-in syndrome. RESULTS: Recanalization of the basilar artery system was successful in seven of the nine patients (a range of 2 to 13 hours after the ictus). Failure to recanalize the basilar artery occurred in two patients, who died after progressing to coma. Complete recovery or only minimal neurologic deficits were demonstrated in five of the nine patients. Despite recanalization of the basilar artery, two patients had no major change in their neurologic function, and both ultimately had severe ataxia and were fully dependent on others. A cerebellar hemorrhage occurred in one patient but without clinical worsening. Two patients had a retroperitoneal hematoma. CONCLUSION: Intra-arterial thrombolysis with urokinase in acute basilar artery occlusion resulted in recanalization in seven of the nine patients (78%). Five of the nine patients recovered fully, including two patients who had had locked-in syndrome. In light of the devastating natural course of acute basilar artery occlusion, these initial results are encouraging and indicate that intra-arterial thrombolysis may be a useful emergency treatment, even in patients with prolonged symptoms of ischemia (up to 12 hours).

Adult↗
PubMed1992

[A case of dissecting aneurysm of the basilar artery extended from the top of the basilar artery to the proximal part].

A rare case of the dissecting aneurysm of the basilar artery is reported. A 48-year-old man was admitted to our hospital because of a sudden onset comatose state. An hour later he recovered consciousness with the residual disturbance of the vertical ocular movement. Computed tomogram on second day revealed low density lesions in the medial part of the bilateral thalamus, and the mesencephalic tegmentum and the cerebellar peduncle on the left side. Cerebral angiograms on the same day and 13th day showed a double lumen sign of the basilar artery and slight extension of the dissecting aneurysm, respectively. However, the cerebral angiogram 6 months after the onset revealed a little bit shrinkage of the aneurysm. The patient was treated conservatively and is in good condition with slight limitation of the downward gaze 10 months after the onset. We reviewed the clinical sign, cerebral angiogram, treatment and prognosis of the dissecting aneurysm of the basilar artery.

Aortic Dissection↗
PubMedDate not supplied

Ophthalmic artery originating from basilar artery: a rare variant.

The basilar artery as the origin of the ophthalmic artery is extremely rare. A 48-year-old patient had undergone angiography for suspicion of a right middle cerebral artery aneurysm. No aneurysm was detected. Vertebral artery injections demonstrated the left ophthalmic artery originating from the basilar trunk. Current embryologic theories fall short in explaining this entity. Awareness of neuroanatomic variations is of paramount importance in diagnosis and treatment of vascular lesions of the brain.

Basilar Artery↗
PubMed2000

Congenital absence of the internal carotid artery and the basilar artery with persistent trigeminal artery associated with coarctation of the aorta.

We report a case of congenital absence of the cervical and petrous part of the left internal carotid artery, the middle and proximal part of the basilar artery, and the V4 segment of the left vertebral artery associated with a left persistent trigeminal artery and a coarctation of the aorta. The left cerebral vessels are supplied via the anterior communicating artery and the left persistent trigeminal artery. The coexisting coarctation of the aorta led to a subclavian steal phenomenon. The alteration of the cerebral hemodynamics has to be taken in consideration when performing cerebral angiography and surgical correction in such a case.

Adult↗
PubMed2004

Intra-arterial thrombolysis in basilar artery occlusion and recent haemorrhagic stroke due to arteriovenous malformation.

We report the case of a young patient suffering from a severe ischaemic stroke due to basilar artery occlusion occurring during selective digital subtraction angiography. This examination was performed in order to assess an arteriovenous malformation in posterior cerebral artery territory responsible for haemorrhagic stroke occurring 17 days before. Intra-arterial thrombolysis with urokinase was performed and basilar artery recanalization was obtained 8 h after stroke onset. Despite the severe neurological impairment, the prolonged symptoms of ischaemia and the high bleeding risk due to the recent cerebral haemorrhage in the same vascular territory involved in thrombolysis, the treatment determined a very favourable clinical outcome.

Adult↗
PubMed1987

Persistent hypoglossal artery associated with basilar artery aneurysm.

A saccular aneurysm at the tip of the basilar artery in a patient with a persistent hypoglossal artery is reported. The persistent hypoglossal artery was arising from the left internal carotid artery. Both vertebral and posterior communicating arteries were absent bilaterally. The combination of a persistent hypoglossal artery and a basilar bifurcation aneurysm is a very rare occurrence. The anatomy of the cerebral circulation in this unique case is important for surgical planning.

Basilar Artery↗
PubMed1996

New ways of performing in vivo flow velocity measurements in the basilar artery.

The basilar artery is the only large artery in which two flows merge, and this is reflected in the flow downstream. We report quantitative flow-velocity measurements with a phase-based MR technique, i.e. the Fourier velocity encoding method, in the basilar artery of a volunteer. To our knowledge, this has not previously been performed successfully. A comparison is made with the results of flow velocity measurements in the basilar artery with transcranial Doppler ultrasonography; the techniques agreed very well. Although Doppler ultrasonography is still most widely used, no information on the flow rate and the flow velocity distribution in the basilar artery can be provided. MR flow measurement techniques appear promising when detailed information on the flow velocity distribution and flow rate is needed.

Adult↗
PubMedDate not supplied

Long-term outcome after local intra-arterial fibrinolysis of basilar artery thrombosis.

Thrombolytic therapy of acute basilar artery (BA) thrombosis has been shown to reduce mortality and avoid a fatal outcome. Objective of this study was to investigate the long-term clinical outcome following intra-arterial fibrinolysis of occlusions of the BA. We retrospectively analyzed the clinical records and neuroradiologic results of 20 consecutive patients who had intra-arterial fibrinolysis of acute occlusions of the BA between 1982 and 1990. All patients were followed neurologically for a period of up to 12 years, including assessment of the Barthel index (BI) and brain CT or MRI studies. 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). Functional outcome was excellent in 9, 78%, of 13 survivors (BI <85). During the cumulative follow-up period (125 patient years) there was 1 death from myocardial infarction and 1 death from pneumonia. Vascular events during follow-up were myocardial infarction (n = 3) and a single cerebral transient ischemic attack. Despite the fact that our series was biased towards patients with severe symptoms, 65% (13/20) survived, and 78% of the survivors reached independence in daily life. These results provide evidence that local fibrinolysis of BA occlusion reduces mortality, and the long-term prognosis of the survivors is better than previously thought. None of our patients had a further stroke during the follow-up period, which indicates that acute BA occlusion is not a strong indicator for advanced arteriosclerotic disease.

Adult↗
PubMed1979

[Roentgenological aspect of the basilar artery and its significance in clinical diagnosis--angiographical study a of the basilar artery (author's transl)].

Topometric study of basilar arteries was performed, using 130 normal vertebral angiograms of cases consisting of 83 males and 47 females aged 2 to 67 (mean = 38.1). The cases having clinically and/or neuroradiologically had obvious positive findings such as cerebral atrophies, cerebrovascular diseases and space-taking lesions were excluded. Selective vertebral angiography using Seldinger's technique in 120 cases and retrograde brachial angiography in remaining 10 cases was carried out. The following results were obtained. 1) The position of vertebrobasilar junction was almost at the midline in frontal view with a mean distance of 0.3 mm +/- 3.6 leftward from the midline. 2) The length of basilar artery was 25.5 mm +/- 6.6 in frontal view and 32.8 mm +/- 5.8 in lateral view. 3) The position of basilar bifurcation was almost at the midline in frontal view with a mean of 0.0 mm +/- 2.0 from the midline, and 9.3 mm +/- 4.7 above the Twining's line and 24.5 mm +/- 3.4 posterior from tuberculum sellae in lateral view. 4) As for the configulation of basilar artery in frontal view, 'straight type' was common in young age and 'curved type' in old age. 'Curved type' was divided into four subtypes. The concave rightwards curved type and/ or the reversed S-formed tortuous type were almost twice many as the concave leftwards curved type and/or the S-formed tortuous type. This result seemed to support the reports on the hemodynamic mechanism of verteral arteries that the dominant flow was present on the left side at the rate of 50 to 80%. 5) Internal diameter of basilar artery at the point of 1 cm proximal to the apex was measured. The mean value was 3.3 mm +/- 0.6 in frontal view and 3.2 mm +/- 0.5 in lateral view. Maximum diameter of basilar artery was 3.5 mm +/- 0.7 in frontal view and 3.6 mm +/- 0.6 in lateral view.

Adolescent↗