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Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
[Megadolicho basilar artery as indication of intensive care relevant vertebrobasilar ischemia]
A Meyer-Lindenberg1, J Mewes, R Biniek
1Neurologische Abteilung, der Rheinischen Landesklinik, Bonn.
Abstract:
An ectasia and enlargement of the basilar artery by a fusiform aneurysm is called megadolicho basilaris. We report five cases with this condition identified at our clinic since 1989, reflecting an incidence of 0.05 percent (5/9300 scans). All patients presented with an acute brainstem syndrome (medullary in 2, pontine in 1 and pontomedullary in 2 patient). With one exception, all cases required intensive care due to respiratory insufficiency. Two patients died, one required total care, and two patients made a good recovery, one of these under therapeutic anticoagulation. All but one patient experienced additional episodes of cerebrovascular ischemia before or after presentation. Vascular risk factors were found in four patients. The detection of a megadolicho basilaris identifies a patient subgroup that is highly prone to vertebrobasilar ischemia and therefore of high significance for neurological intensive care medicine. Recurrence rate for ischemia is high. While even a severe brainstem syndrome may be reversed under anticoagulation in the individual case, presence of multiple vascular risk factors often prevents the employment of this treatment modality.
Insights
Megadolichobasilaris, an enlargement of the basilar artery, is rare but leads to severe brainstem syndromes and high risks of vertebrobasilar ischemia. Early detection is crucial for managing this high-risk patient subgroup.
Area of Science:
- Neurology
- Vascular Neurology
- Neurocritical Care
Background:
- Megadolichobasilaris, characterized by ectasia and enlargement of the basilar artery due to a fusiform aneurysm, presents a diagnostic challenge.
- This condition is associated with significant morbidity and mortality, often manifesting as acute brainstem syndromes.
Observation:
- Five cases of megadolichobasilaris were identified over 30 years, with an incidence of 0.05% (5/9300 scans).
- All patients presented with acute brainstem syndromes (medullary, pontine, or pontomedullary), frequently requiring intensive care for respiratory insufficiency.
- A high rate of recurrent cerebrovascular ischemia was observed in affected patients.
Findings:
- Two patients died, one required total care, and two recovered well, with one benefiting from therapeutic anticoagulation.
- Vascular risk factors were prevalent in four out of five patients, complicating treatment decisions.
- The study highlights a high recurrence rate for ischemia in patients with megadolichobasilaris.
Implications:
- Megadolichobasilaris identifies a high-risk subgroup prone to vertebrobasilar ischemia, emphasizing its significance in neurocritical care.
- While anticoagulation can reverse severe brainstem syndromes, coexisting vascular risk factors may preclude its use.
- Effective management strategies are crucial for improving outcomes in patients with this rare but severe vascular condition.
