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[Occlusion of the basilar artery. A review with 17 personal cases (author's transl)]
Insights
Basilar artery occlusion, often from atherosclerosis, leads to severe brainstem and cerebral infarctions. This condition has a high fatality rate, with angiography being key for diagnosis and general management being the primary treatment.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Basilar artery occlusion (BAO) is a critical neurological event, predominantly caused by atherosclerosis.
- Less common etiologies include embolism, dissection, trauma, and arteritis.
- Understanding BAO's classification and impact is vital for patient outcomes.
Purpose of the Study:
- To classify basilar artery occlusions based on pathological and angiographic findings.
- To detail the clinical presentation and prognosis of basilar artery occlusion.
- To evaluate diagnostic and management strategies for basilar artery occlusion.
Main Methods:
- Classification of BAO into segmental, plurisegmental, and extensive types using pathological and angiographic data.
- Analysis of infarcted areas, including brainstem, cerebellum, diencephalon, and cerebral hemispheres.
- Review of clinical manifestations, diagnostic tools (angiography, CT), and management approaches.
Main Results:
- Angiography is the definitive diagnostic tool for basilar artery occlusion, also revealing collateral circulation.
- Computed tomography aids in excluding other posterior fossa pathologies.
- Clinical presentation includes transient ischemic attacks followed by decreased consciousness and motor deficits, with an 85.98% mortality rate.
Conclusions:
- Basilar artery occlusion is a severe condition with a high mortality rate, primarily diagnosed via angiography.
- Infarction patterns involve critical brain structures, leading to significant neurological deficits.
- Current management is largely supportive, though carotid artery stenosis intervention may improve collateral flow.
Abstract:
Occlusion of the basilar artery is mainly of atherosclerotic origin; embolic occlusion, dissecting aneurysm, trauma and arteritis are less frequent. Pathologic and angiographic findings allow to classify basilar artery occlusions in three types: segmental (superior, medial or inferior), plurisegmental and extensive. The infarcted areas involve brain stem, especially pons and cerebellum, also diencephalon and cerebral hemispheres, in various combinations. Clinically, there is typically a prodromic stage, with transient ischemic attacks (vertigo, headaches, visual disturbances, motor deficit). Few weeks later, a decreased level of consciousness and motor anomalies are the most important signs. A fatal outcome is noted in 85,98 p. 100. Among laboratory examinations, only angiography proves the occlusion: it also shows the arterial supply (carotido-basilar reflux; inter-cerebellar anastomosis). Computed tomography usually eliminates an expanding mass of the posterior fossa. Management is only of general type. Surgical management of carotid arteries stenosis may ameliorate the anastomotic flow.