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[Acute occlusion in the vertebrobasilar circulatory system in children and young adults]
Insights
This study highlights the challenges in diagnosing vertebrobasilar artery occlusions in young patients. Early diagnosis and treatment, including local fibrinolysis, significantly improved outcomes and recovery rates.
Area of Science:
- Neurology
- Vascular Medicine
Background:
- Vertebrobasilar artery occlusions are rare in patients under 50.
- Delayed diagnosis and treatment are common, impacting patient outcomes.
Purpose of the Study:
- To evaluate treatment outcomes for acute vertebrobasilar artery occlusions in young patients.
- To assess the efficacy of different therapeutic strategies, including conservative management and local fibrinolysis.
Main Methods:
- Retrospective analysis of ten patients under 50 years with vertebrobasilar artery occlusions.
- Diagnosis confirmed by selective angiography.
- Treatment included low-molecular dextranes, heparin, prostaglandin E1, and local fibrinolysis.
Main Results:
- Local fibrinolysis achieved complete recanalization in 3 cases and partial in 2.
- Three patients treated with local fibrinolysis survived with near-complete recovery.
- Conservative treatment resulted in survival and minor neurological deficits in one patient.
Conclusions:
- Prompt diagnosis and intervention are crucial for improving outcomes in young patients with vertebrobasilar artery occlusions.
- Local fibrinolysis appears to be an effective treatment option, leading to significant recanalization and recovery.
Abstract:
Within four years ten patients (six women and four men) under 50 years of age (13-49 years) were observed who presented occlusions of the vertebrobasilar artery. Eight patients were admitted from other hospitals, on an average 41 hours after the acute occlusion; only in one case had a correct first diagnosis been made. In all cases diagnosis was confirmed by means of selective angiography. Conservative treatment comprised in two patients low-molecular dextranes and heparin, in another two prostaglandin E1. In the remaining six patients local fibrinolysis was performed. In the group receiving conservative treatment a 33-year-old female patient survived and her neurological deficits subsided except for an organic psychosyndrome of minor degree. Local fibrinolysis yielded complete recanalization in three cases and partial recanalization in two. Three patients survived, in two patients near-complete recovery was achieved.