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[Dissections of the basilar artery]
H Urbach1, A Meyer-Lindenberg, M Bendszus
1Radiologische Klinik, Funktionseinheit Neuroradiologie Universität Bonn.
Insights
Basilar artery dissections present as two types: subintimal dissections causing vertebrobasilar ischemia and subadventitial dissections leading to subarachnoid hemorrhage. These findings aid in understanding basilar artery dissection presentations.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Basilar artery dissections are rare but critical vascular events.
- Understanding their diverse clinical presentations is crucial for timely diagnosis and management.
Observation:
- A study reviewed four patients with basilar artery dissections diagnosed via angiography.
- Clinical, radiological (angiography, MRI), and pathological data were correlated with patient outcomes.
Findings:
- Three patients exhibited subintimal dissections causing vertebrobasilar ischemia, with vessel wall irregularities noted on angiography.
- One patient presented with a post-traumatic basilar artery aneurysm.
- Autopsy in one case revealed a dissecting hematoma between the intima and media.
Implications:
- Basilar artery dissections can be classified into two main types based on pathological and clinical features.
- Subintimal dissections manifest as vertebrobasilar ischemia, often without the typical delay seen in extracranial dissections.
- Subadventitial dissections can lead to subarachnoid hemorrhage due to adventitial rupture.
Purpose:
To describe clinical, radiological and pathological-anatomical findings of basilar artery dissections.
Methods:
During a period of three years (1994-1996) we observed 4 patients with dissections of the basilar artery, proven by angiography. Angiograms, MRI (n = 2) and autopsy results (n = 1) of these patients were correlated with clinical symptoms and long-term follow-up.
Results:
In three patients the dissection was confined into the basilar artery. Three patients with vertebrobasilar ischaemia showed irregularities of the vessel wall on angiography, in one of these patients autopsy revealed a haematoma within the vessel wall, located between intima and media. One patient complaining of relapsing headaches had a posttraumatic basilar artery aneurysm.
Conclusion:
Dissections of the basilar artery can be separated in two types. In case of subintimal dissection patients present with vertebrobasilar ischaemia, which in contrast to extracranial dissections usually occurs without temporal delay. A second type of patients presents with subarachnoid haemorrhage. The dissection is subadventitial and pierces through a thin adventitia into the subarachnoid space.