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The authors report a double aneurysm of the basilar artery located at the basilar artery bifurcation and upper basilar artery trunk between the posterior cerebral artery and the superior cerebellar artery. Clinical presentation, neuroradiological findings, surgical approach, and the operative technique are described and discussed.
Basilar artery occlusion was diagnosed by high-resolution computed tomography (CT) in 11 cases. The normal basilar artery imaged on plain CT scans has an attenuation value not higher than that of whole blood. If the CT attenuation value of the vessel is higher than that of blood, basilar artery occlusion is probably present. The tentative diagnosis can be confirmed by comparison of the attenuation values on the pre- and postcontrast scans, preferably using multiple slices obtained by multiplane dynamic CT.
Locked-in syndrome is a dramatic clinical condition, the patient is awake, can listen and breath, but is unable to move any muscle, conserving only the vertical eye movements. The most common cause of locked-in syndrome is the thrombosis of the basilar artery and commonly leads to death, frequently due to pneumonia. Intravenous and intra arterial thrombolysis have been used successfully in a selective group of patients with ischemic stroke. There is only one report of two patients with locked-in syndrome who were treated successfully with intra arterial thrombolysis. Other authors, based in their experiences, do not recommend this treatment. We report two female patients aged 63 and 26 years, with Locked-in syndrome due to a basilar thrombosis who were treated successfully with intra arterial thrombolysis using recombinant tissue plasminogen activator (r-TPA). The lapses between the onset of the symptoms and thrombolysis were 5 and 8 hours respectively. A complete recanalization was obtained in both patients during the thrombolysis. One year after, the first patient has only a moderate ataxia, walking with assistance and the other has a normal neurological examination.
We report a patient presenting with subarachnoid haemorrhage due to rupture of a giant fusiform aneurysm of the proximal basilar artery. The aneurysm was successfully treated by reversing blood flow in the basilar artery by balloon occlusions of both vertebral arteries proximal to the posterior inferior cerebellar artery origins. Substantial thrombosis and regression of the aneurysm was evident 4 months later.
Aneurysms of the basilar artery are uncommon. Historically, because of the central location of these basilar lesions, surgical access has been difficult. Moreover, while this disease and its surgical management inherently carry a high risk of patient morbidity, the presence of neighboring vital neural and vascular structures introduces additional intraoperative challenges. Since 1986 we have employed a transpetrous approach for access to selective aneurysms involving the basilar artery. Removal of the petrous apex has provided an expanded deep window through which infraclinoidal basilar artery aneurysms can be controlled. Reported herein are our results utilizing an anterior petrosectomy approach to the management of infraclinoidal artery aneurysms.
Basilar artery occlusion is usually associated with a poor prognosis. Nevertheless, intra-arterial thrombolysis has been shown to improve clinical outcome in selected cases. We report the case of a 29-year-old patient who suffered a severe ischemic stroke due to basilar artery occlusion and who was treated with intra-arterial thrombolysis within 3 h of symptoms onset; treatment was followed by an almost full functional recovery. The young age of the patient, short segment occlusion in the middle tract of the artery, good collateral supply, and early recanalization may account for the favorable prognosis.
Basilar artery migraine is a rare headache characterized by attacks preceded and/or accompanied by transitory focal neurologic symptoms that point to dysfunction in the region irrigated by the basilar artery and its branches. Clinical variation in presentation can complicate differential diagnosis. We review the clinical characteristics, diagnostic criteria, complementary tests and most frequent results, as well as the differential diagnoses to be taken into consideration. We also suggest possible prophylactic and therapeutic measures based on recent genetic studies.
Basilar artery migraine is a distinctive disorder characterized by recurrent occipital headache with typical migrainous phenomena in conjunction with a variety of symptoms referable to a transient dysfunction of the brainstem, the cerebellum and the occipital lobes. Impairment of consciousness is a common feature but is usually too brief to be captured by electroencephalography. Here we report an unusual case of basilar artery migraine with prolonged attacks of impaired consciousness lasting more than two weeks, thus allowing electroencephalographic follow-up. In the acute stage, EEG showed marked generalized slow wave delta activity. After the attack, both the electroencephalographic and clinical findings subsided within the following weeks.
PURPOSE: To demonstrate that the in vivo flow from individual vertebral arteries can be imaged and tracked in the basilar artery by use of saturation planes with three-dimensional time of flight MR angiography. METHODS: Twenty volunteers were studied with intracranial three-dimensional time of flight angiography MR. The MR angiography was repeated with saturation of the individual vertebral arteries. Flow voids and signal intensity within the basilar and posterior cerebral arteries were evaluated for flow patterns. RESULTS: Of 15 volunteers with a "normal" vertebrobasilar anatomy, 80% demonstrated a pattern of flow within the basilar artery in which the contributing vertebral components remained ipisilateral. This pattern was called "parallel." A "spiral" pattern of rotation of the contributing vertebral components was found in 20% of studies. The inflow to the posterior cerebral arteries could be identified from specific vertebral contributions and was related to the size-dominance of the vertebral artery. CONCLUSION: There is nonadmixture of vertebral artery flows of variable duration within the basilar artery; at least two patterns of flow can be described within the basilar artery. The method presented is a simple technique for determining vertebral artery flow components with routine software and without secondary data manipulation.
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Transmural nerve stimulation (TNS) induced relaxations in porcine and bovine basilar arteries which were abolished by tetrodotoxin (TTX) and by L-nitro-arginine (LNAG). However, TNS induced contractions in equine basilar artery which were abolished by TTX and by guanethidine, but not by LNAG. These results suggest that the TNS-induced contractions of equine basilar arteries may be mediated by norepinephrine release.
A 70-year-old man, with regional herpes zoster (C2) of 10 weeks duration, died following subarachnoid hemorrhage caused by the rupture of an aneurysm in the basilar artery. Granulomatous angiitis, with multinucleated giant cells, was found at autopsy in the wall of the aneurysm. Electron microscopy of the basilar artery disclosed intracytoplasmic viral particles with an envelope which measured 150-220 nm in diameter. Immunohistochemistry studies revealed varicella-zoster-virus-related antigen in the cytoplasm and/or in the nucleus of histiocytes in the vessel wall. These findings suggest that varicella-zoster virus may be linked to the development of granulomatous angiitis.
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The objective of this study was to clarify the clinical and radiologic features, risk factors, and prognosis of basilar embolism without permanent basilar artery occlusion. Forty-five patients (mean age, 59 years) with basilar artery embolism participated in the study. Patients with basilar artery occlusion were excluded. The Glasgow Coma Scale (GCS) score on admission was < 7 in five patients, 7 to 12 in 11 patients, and > 12 in 29 patients. Etiologic factors were cardiac arrhythmia (17 patients), vertebral artery occlusion (12 patients), cervical spine trauma (4 patients), embolism following angiography (2 patients), and surgery (1 patient). MRI was performed in 17 patients and CT in 39 patients. Radiologic examinations were initially normal in 14 patients and remained normal in three patients. Final infarct localization was the thalamus (36 patients), cerebellum (20 patients), posterior cerebral artery territory (21 patients), midbrain (12 patients), and pons (8 patients). Eight to 12 weeks after stroke 12 patients were without clinical signs (Glasgow Outcome Scale [GOS] 1), 15 patients had minor neurologic deficits (GOS 2), 10 were severely disabled (GOS 3), and eight patients had died (GOS 5). Outcome correlated with GCS on admission (p < 0.0001) and with the number of ischemic lesions (p = 0.0001). The typical syndrome is an acute loss of consciousness followed by multiple brainstem symptoms. Usually, clinical symptoms improve rapidly and, in some patients, completely. Compared with basilar occlusion, basilar embolism has a relatively low mortality and outcome is frequently excellent.
Basilar artery thrombosis is an infrequent but important neurological emergency requiring early diagnosis and treatment. Of particular relevance to emergency medicine is the recognition and consideration of the unusual signs that may be present in an often previously well patient. It is therefore crucial to expedite investigations, confirm the diagnosis and commence life-saving treatment through the early involvement of a number of disciplines including neurology, radiology and intensive care. This paper confirms the use of magnetic resonance imaging and angiography as the preferred investigative mode and microcatheter directed intra-arterial thrombolysis as the treatment strategy of choice.
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Three cases of basilar artery territory infarction, in which a dense basilar artery was noted, are described. The dense basilar artery was recognized on computed tomography (CT) by comparing its density with that of other unaffected intracranial vessels. This sign is thought to represent basilar thrombosis or embolism and has similarities to the dense middle cerebral artery sign. The dense basilar artery is an early sign suggesting basilar territory infarction and its use improves the CT detection of basilar territory infarction.
Basilar artery (BA) stenting is an emerging technique with promising results in revascularization of severe arteriosclerotic stenoses. Because of the limitations associated with other noninvasive techniques, we applied transcranial color-coded sonography (TCCS) in the follow-up. Successful stent application in two cases of acute basilar occlusion caused by thrombosis on pre-existing severe midbasilar stenoses was initially confirmed by angiography. Later recanalization was controlled noninvasively by magnetic resonance angiography (MRA), computed tomographic angiography (CTA) and TCCS. Ultrasound (US) was performed through the transtemporal bone window; a contrast-enhancing agent had to be used in one case. TCCS showed an orthograde flow in the distal BA in both patients without signs of severe stenoses. Transtemporal TCCS was demonstrated to be a noninvasive bedside technique in monitoring the patency of the BA after stenting.