Basilar Arterial Occlusion

[HollyJ]

Hi everyone,
My grandfather was just diagnosed with Basilar Arterial Occlusion. Since I'm only starting med school in the fall, I have no idea at all what that means. Well, I understand what all of the words mean, but I don't know what the implications are.

I would really, really appreciate any information that you could give me or any sources that you could point me towards.

Thanks.

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[carrigallen]

Hi HollyJ,

I am a first year medical student, so I am not professionally qualified to answer your question.

I think that a Basilar Artery Occlusion is a blockage of the Basilar Artery, caused by a stroke. I believe it has a high fatality rate, sadly. Patients who survive rarely gain independence and are probably at risk for more strokes.

It is most often caused by embolism from a plaque in vertebral artery, although I think it may also result from thrombotic processes (drugs, brainstem surgery), or meningitis.

Since the basilar is large, it is fairly rare compared to other forms of stroke. It controls much of our autonomic functions, so patients who survive are often on ventilators. Comadin is a commonly used drug to prevent more strokes. New procedures like embolectomies may come out for acute cases.

I'm sorry to hear about your grandfather, it must be rough for your family. Good luck with med school.

 

[IMGforNeuro]

hi HollyJ,
I can understand how tough it must be for you and your family. My own grandfather had a middle cerebral artery stroke. It really tests you emotionally.
Complete occlusion of the basilar artery is very devastating. It leads to brain stem infarction with bilateral long tract signs(loss of sensations and movement) along with cranial nerve palsies and cerebellar dysfunction (as loss of balance and coordination). There could be stupor (deterioration of consciousness) due to dysfunction of reticular activating system.
Commonly there are incomplete basilar artery syndromes depending on site and extent of occlusion and also due to collateral circulation (blood flow from the internal carotid system). Patients could develop 'locked in' state with awake quadriplegia, paralysis of face, palate and horizontal gaze palsy.
Depending on the branch of the basilar artery occluded there are various combinations of long tract (sensory, motor) cranial nerve and cerebellar signs.
Many times, it starts with unilateral features with shortlived repetitive episodes. These are actually TIAs(transient ischemic attacks). They occur because of gradually reducing blood flow and eventually lead to a complete stroke with bilateral signs. There could also be episodes of bilateral attacks (TIAs). TIAs are warning signs of impending stroke (infarction).
Transcranial doppler (through the foramen magnum window) can be used to assess blood flow in the vertebrobasilar circulation. It is a new modality.
It is sadly among the strokes that are difficult to manage with not a good prognosis.
Atherosclerotic basilar artery disease, the most common site is at the bifurcation of BA into posterior cerebral arteries. This could produce a complex syndrome of bilateral post cerebral artery depending on the amount of collateral flow from the post communicating arteries. Basilar artery stenting is available in select basilar artery stenosis.
I hope your grandfather had a basilar artery TIA so that he could take prophylactic treatment to prevent further attacks.
There is a great deal of info available on cerbrovasc dis in most neuro textbooks. Harrisons (Principles of Internal Med, Vol 2) has a great chapter on stroke syndromes.

 

[HollyJ]

Thank you so much for the information, you two -- I appreciate it more than I can tell you. I'm sorry about your grandfather, IMG.

Apparently, his neurologist has told him that any surgical intervention is more or less out of the question. He is currently on medication, although it is making him very dizzy. I am trying to get him to come to Houston (he's in west Texas) for a second opinion, but I'm meeting with a lot of resistance. He's a doctor himself, and for some reason, that makes him reluctant to visit any doctor, much less a specialist.

Thanks again for the information. It's not happy information, but I'd rather have some idea of what's going on.