Acute primary cerebral angiitis mimicking basilar artery dissection

Two patients presented with acute severe occipital headache, neck pain, nausea, vomiting and blurred vision. In both patients angiograms of the posterior circulation showed focal narrowing of the basilar artery, thus basilar artery dissection was considered. Urgent magnetic resonance imaging (MRI) was unavailable. On the basis of additional angiography of the anterior circulation and control angiograms after 4 and 6 weeks, primary cerebral angiitis was the most probable diagnosis. Treatment with corticosteroids resulted in rapid clinical and angiographic improvement. We conclude that, when MR techniques are unavailable or inconclusive, presumption of basilar dissection on the base of clinical features, Doppler studies, Duplex scanning and angiography of the vertebro-basilar system should be confirmed by additional carotid angiography in order to exclude diffuse cerebral angiitis.     

Severe ethylene glycol intoxication mimicking acute basilar artery occlusion

We report a patient with severe ethylene glycol poisoning initially mimicking acute basilar artery occlusion and elucidate the importance of immediate diagnosis and treatment: a previously healthy 59-year-old truck driver presenting with hallmarks of basilar artery syndrome after having consumed an unknown substance. Immediate application of intravenous ethanol and hemodialysis could not prevent the development of a malignant brain edema within hours. This report describes a new clinical presentation of severe ethylene glycol intoxication mimicking acute basilar artery occlusion with the development of a fatal brain edema within hours, despite adequate treatment.     

Acute aortic dissection presenting as painful paraplegia

Aortic dissection is a rare potentially life threatening condition. Neurological complications such as paraplegia as presenting manifestation of aortic dissection are exceedingly rare. We describe a 60-year-old man who presented with acute onset paraplegia with bladder involvement, constricting pain in the lower abdomen, bradycardia and succumbed rapidly within 14h of onset of symptoms. Autopsy revealed an unexpected cause of paraplegia with extensive aortic dissection extending from origin to iliac bifurcation (DeBakey type I). The aorta showed extensive atherosclerosis causing medial destruction and dissection. The spinal cord in the vulnerable watershed zone of T12-L1 downwards revealed ischemic softening. No infarcts were seen in other organs as he succumbed rapidly to cardiac tamponade. Acute aortic dissection presenting as paraplegia though rare, should be considered in patients presenting with sudden onset paraplegia with associated severe pain and absent pulses. Prompt diagnosis and timely intervention may help save life and limb.     

Acute basilar artery occlusion: topographic study of infarcts

OBJECTIVE: To determine the ischemic lesions distribution and extension of patients with basilar artery thrombosis by the means of magnetic resonance imaging (MRI). METHODS: In 17 patients with thrombosis of the basilar artery, MRI was performed, including T2-weighted, magnetic resonance angiography (MRA) and diffusion-weighted imaging (DWI) sequences in the short-term phase (<48 hours). The shapes of ischemic lesions were obtained by graphic software and overlapped on a representative layer outline background. RESULTS: The MRA showed basilar artery occlusion in all cases and the DWI revealed different patterns of ischemic lesions. Most patients showed multiple lesions within the posterior circulation territory. Lesions more often occurred in pontes, cerebellums and mesencephalons than medullas, thalami and occipital lobes. Basilar pons, cerebral crus and cerebellum hemisphere were more susceptible than pontine tegmentum, vermis, midbrain tegmentum and tectum. CONCLUSIONS: When the basilar artery is occluded, basilar pons, cerebral crus and cerebellum hemisphere were most susceptible. The branches with smaller lumen of basilar artery, which are easier to be affected, are thought to be the cause of such a phenomenon.     

Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage

Basilar artery dissection (BAD) is a rare condition with a worse prognosis than a dissection limited to the vertebral artery. We report a rare case of chronic BAD with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage (SAH) in a 54-year-old woman. The diagnosis of acute BAD could only be made retrospectively, based on clinical and neuroradiological studies from a hospital admission 10 months earlier. Angiography performed after her SAH showed unequivocal signs of imperfect healing; she was either post-recanalization of a complete occlusion or post-dissection. Residual multi-channel intraluminal defects led to the development of a small aneurysm, which was responsible for the massive hemorrhage. The occurrence of an associated aneurysm, and wall disease, but not an intraluminal process, reinforces the diagnosis of dissection. The patient was fully recovered at 90 day follow-up. This case reinforces the need for long-term neuroradiological surveillance after non-hemorrhagic intracranial dissections to detect the development of de novo aneurysms.     

Acute basilar artery occlusion treated by thromboaspiration in a cocaine and ecstasy abuser

Thromboaspiration was performed in a young adult in a coma because of acute basilar artery occlusion associated with cocaine and ecstasy abuse 30 hours after symptom onset. There was complete recanalization of the basilar artery and favorable recovery. Because cocaine and ecstasy abuse has been reported to be a risk factor for ischemic stroke and fatal brain hemorrhage, thromboaspiration may be an alternative therapy to thrombolysis.     

Isolated basilar artery occlusion associated with a clivus fracture

Most vascular injuries to the brain secondary to blunt head trauma involve the internal carotid circulation. A case of isolated basilar occlusion secondary to a clival fracture is described and compared to three other cases in the literature.     

Vertebral artery dissection complicated by basilar artery occlusion successfully treated with intra-arterial thrombolysis: three case reports

Cervical artery dissection is an important cause of stroke in young patients and accounts of 10%–20% of stroke or TIA in patients aged less than 50 years. Basilar artery occlusion (BAO) is an infrequent cause of acute stroke, which invariably leads to death or long-term disability if not recanalized. We describe three patients with BAO caused by vertebral dissection, successfully treated with intra-arterial thrombolysis. The lysis of the occluding embolus was obtained by injection of the thrombolytic drug directly or near the thrombus without haemor-rhagic complications. Our cases confirm the safety and efficacy of intra-arterial thrombolysis in patients with BAO due to a vertebral artery dissection.     

Outcome in patients with basilar artery occlusion treated conventionally

BACKGROUND: Most data on the outcome of basilar artery occlusion are from recent case series of patients treated with intra-arterial thrombolysis. The limited knowledge on the outcome after a conventional treatment approach comes from a few small case series of highly selected patients. OBJECTIVE: To provide more data on the outcome of conventional treatment. METHODS: Data were analysed on patients from three centres with symptomatic basilar artery occlusion treated conventionally. Conventional therapy was defined as treatment with antiplatelets, anticoagulation, or both. RESULTS: Data were available on 82 patients. The case fatality was 40%. Among survivors, 65% remained dependent (Rankin score 4-5). Patients younger than 60 years (odds ratio = 3.1 (95% confidence interval, 1.0 to 9.5)) and those with a minor stroke (OR = 3.1 (1.0 to 9.6)) were more likely to have a good outcome (Rankin score 0-3). Patients with a progressive stroke were less likely to have a good outcome (OR = 0.3 (0.08 to 1.2)) than patients with a maximum deficit at onset or fluctuating symptoms at presentation. CONCLUSIONS: Conventional treatment of symptomatic basilar artery occlusion is associated with a poor outcome in almost 80% of patients, which emphasises the importance of the search for a more effective treatment approach.     

An unusual case of neuro-Behçet’s disease presenting with reversible basilar artery occlusion

Abstract Neuro-vasculo-Beh?et’s disease is considered a venous vessel disease generally in the form of cerebral venous thrombosis. Arterial involvement has been rarely reported. We present a patient with neuro-Beh?et’s disease who developed reversible basilar artery occlusion. To the best of our knowledge, this is the first case of neuro-Beh?et’s disease presenting with reversible basilar artery occlusion. Beh?et’s disease should be considered in the differential diagnosis of basilar artery occlusion.     

Magnetic resonance imaging in basilar artery occlusion

CONTEXT: Acute basilar artery occlusion has particularly high mortality and morbidity. OBJECTIVE: To determine the potential utility of advanced magnetic resonance imaging (MRI) methods, including diffusion-weighted imaging, for the early management of patients with basilar artery thrombosis. DESIGN: Case series. SETTING: Institute of Neuroradiology and Department of Neurology, Johann Wolfgang Goethe University, Frankfurt, Germany. PATIENTS: In 4 patients with occlusion of the basilar artery, MRI was performed, including T2-weighted and diffusion-weighted imaging (DWI) sequences and magnetic resonance angiography (MRA) in the short-term phase (<12 hours). Three patients underwent intra-arterial thrombolysis. Clinical outcome was obtained 10 days after symptom onset. RESULTS: The MRA was performed 3.5 to 11.5 hours after symptom onset and showed basilar artery occlusion in all cases. The DWI revealed different patterns of ischemic lesions. In 2 patients, no or only small lesions could be identified; the remaining showed multiple and large lesions within the posterior circulation territory. Initial clinical status was severely impaired in all cases (Rankin scale score, 4-5). Thrombolysis was initiated in 3 patients, leading to successful recanalization in 2. Clinical outcome was favorable in the 2 patients with small DWI lesions and successful reperfusion (Rankin scale score, 2), whereas it was worse in those with large DWI lesions and persisting occlusion (death, persisting coma). CONCLUSIONS: In critically ill patients with acute basilar occlusion, the extent of DWI lesion involvement can be highly variable. Small DWI lesions seem to be associated with a favorable outcome if reperfusion is achieved with thrombolysis. This could potentially be the case independent of time from symptom onset.     

Acute bilateral deafness and facial diplegia as a presentation of occlusion of the basilar artery

INTRODUCTION: Sudden bilateral deafness and facial weakness are unusual presentations of brain stem stroke. OBSERVATION: We report the case of a patient who presented successively sudden bilateral deafness and facial diplegia in correlation with a brain stem stroke but without any ischemic pontine lesion. DISCUSSION: Unlike our case, all of the earlier publications, have reported the presence of ischemic pontine lesions in patients with bilateral deafness and facial diplegia. Selective vulnerability of inner ear to ischemia has been hypothesized but cannot explain the facial diplegia. CONCLUSION: Our case would suggest extra-neuraxis failure by ischemia of the acoustico-facial nerve.     

基底动脉末段动脉瘤术中基底动脉的临时阻断

目的探讨基底动脉末段动脉瘤显微外科术中采用基底动脉临时阻断(TBAO)的可行性.方法回顾性分析892例基底动脉末段(基底动脉分叉部和基底动脉-小脑上动脉)非巨大动脉瘤显微外科术中采用TBAO与非TBAO的疗效并进行比较.结果单次阻断不超过5 min比较安全,超时或重复阻断则病残和死亡率增加;TBAO应慎重地用于术前不良分级、老年和多发性动脉瘤的患者,阻断的同期使用低血压(平均动脉压<70 mmHg)应视为禁忌.结论基底动脉动脉瘤早期外科治疗中采用TBAO较非TBAO疗效好.     

Painless aortic dissection presenting as a progressive myelopathy

We report a patient with a painless aortic dissection whose neurologic symptoms progressed over 5 days to a complete transverse myelopathy. She did not experience pain as her neurologic deficits evolved. Magnetic resonance imaging revealed a thoracic aortic dissection extending from the arch to the level of the 12th thoracic vertebra and demonstrated ischemic changes in the spinal cord and one thoracic vertebral body. Aortic dissection must be included in the differential diagnosis of spinal cord syndromes even in the absence of pain. Early recognition of aortic dissection as a cause of progressive myelopathy may become increasingly important as new therapies for central nervous system ischemia are developed.