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BASILAR ARTERY EMBOLISM AND OCCLUSION.

Non-occlusive basilar artery embolism has a variable presentation and prognosis, but many patients do quite well without specific acute treatment, according to this study of 45 patients. The patients were diagnosed with emboli in the basilar territory, according to clinical and imaging criteria, but none had occlusion of the basilar artery. Most patients had depressed levels of consciousness initially, but many were improving spontaneously at the time of admission. Other common signs were gaze palsies (64 percent), hemiparesis (44 percent), dysarthria (42 percent), pupil abnormalities (40 percent), and ataxia (36 percent). At 8 to 12 weeks, 60 percent were asymptomatic or had minor neurological deficits, 22 percent were severely disabled, and 18 percent had died.

In a second study, researchers from the Mayo Clinic attempted intra-arterial thrombolysis in nine patients with occlusive basilar thromboembolism, which, by contrast, has an extremely poor prognosis. On admission, all had brainstem ischemic signs of varying severity. Urokinase was infused into the proximal aspect of the thrombus 2 to 13 hours after symptom onset, and six patients had complete recanalization of the artery. Five patients had full recovery, two had persistent severe deficits, and two died.

Comment: Taken together, these reports present a good overview of basilar artery ischemic syndromes. Intra- arterial basilar artery thrombolysis has now been reported from several centers, but patient selection criteria for this procedure are not yet clear.

— AS Brett

Published in Journal Watch General Medicine December 12, 1997

Citation(s):

Schwarz S et al. Basilar artery embolism: Clinical syndrome and neuroradiologic patterns in patients without permanent occlusion of the basilar artery. Neurology 1997 Nov 49 1346-1352.

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• Medline abstract (Free)

Wijdicks EFM et al. Intra-arterial thrombolysis in acute basilar artery thromboembolism: The initial Mayo Clinic experience. Mayo Clin Proc 1997 Nov 72 1005-1013.

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• Medline abstract (Free)