IMAGES IN NEUROLOGY
Year : 2007 | Volume
: 10 | Issue : 1 | Page : 61--62
Basilar artery thrombosis
Apollo Hospitals, Hyderabad, India
Apollo Hospitals, Jubilee Hills, Hyderabad - 500 033, Andhra Pradesh
|How to cite this article:|
Kumar S. Basilar artery thrombosis.Ann Indian Acad Neurol 2007;10:61-62
|How to cite this URL:|
Kumar S. Basilar artery thrombosis. Ann Indian Acad Neurol [serial online] 2007 [cited 2020 Aug 8 ];10:61-62
Available from: http://www.annalsofian.org/text.asp?2007/10/1/61/31490
A 55-year old gentleman was found to be unconscious at 7 pm and transferred to our hospital seven hours later. On admission, he was deeply comatose, with bilateral equal and reactive pupils and decerebrate posturing. Meningeal signs were absent. CT scan of the brain was done, which was normal. He was electively intubated and mechanically ventilated. Toxic and metabolic screening was done, reports of which were normal. Twenty-four hours later, the patient was found to have anisocoria and decerebrate posturing. MRI was done which showed extensive infarcts involving bilateral occipital lobes, brainstem, thalamus and cerebellum [Figure 1],[Figure 2]. Hydrocephalus, a known complication, is also noted. MR angiogram showed complete basilar artery occlusion [Figure 3].
Intra-arterial thrombolysis (IAT) could be successfully used, if basilar artery thrombosis is diagnosed early. Without recanalization of occluded basilar artery, the likelihood of good outcome (no death or dependency) is close to nil. On the other hand, intravenous thrombolysis (IVT) or IAT leads to recanalization in 55-65% of the patients and good outcome in about 20-25% of the patients. In a case series of 12 patients, mechanical recanalization (mechanical disruption or thrombus retrieval using various loop-shaped tools) of basilar artery was successful in 50% of the patients and helped in saving rt-PA dose and time. It was also found to be safe.
This case is presented to highlight the typical imaging findings of basilar artery occlusion and to also point out the fact that basilar artery thrombosis should be considered in cases of unexplained coma, as early diagnosis and thrombolytic therapy could be life-saving in such patients.
|1||Lindsberg PJ, Mattle HP. Therapy of basilar artery occlusion: A systematic analysis comparing intra-arterial and intravenous thrombolysis. Stroke 2006;37:922-8. |
|2||Bergui M, Stura G, Daniele D, Cerrato P, Berardino M, Bradac GB. Mechanical thrombolysis in ischemic stroke attributable to basilar artery occlusion as first-line treatment. Stroke 2006;37:145-50.|