Magnetic resonance imaging for vertebral-basilar system infarction

The rehabilitative course for patients who have suffered vertebral-basilar vascular lesions is often interrupted by intermittent episodes of increasing dizziness, nausea, vomiting, and ataxia. Since CT studies of the brain do not always visualize these lesions reliably, the rehabilitation specialist has been without a diagnostic tool to distinguish between progressive and stable vertebral-basilar system infarctions. Magnetic resonance imaging (MRI) offers a safe, noninvasive, sensitive means of monitoring vascular lesions in the posterior fossa. The purpose of this study was to use MRI to evaluate patients with suspected vertebral-basilar vascular lesions. In three patients studied, MRI was superior to CT scan. Advantages of MRI included lack of artifact due to bone scattering from ionizing radiation, ability to image directly in the sagittal plane, visualization and localization of pathologically smaller lesions, and potential for performing serial studies without exposing patients to large doses of radiation. In each case, MRI data yielded valuable adjunctive information that aided further rehabilitation evaluation and management. We conclude that MRI may be a useful diagnostic and prognostic tool in evaluating and managing rehabilitation patients with vascular lesions involving the vertebral-basilar system.