Acute Basilar Artery Occlusion Presenting With Convulsive Movements: A Systematic Review

Background and Purpose: Convulsive seizures related to posterior circulation stroke are considered rare. However, some patients with acute basilar artery occlusion (BAO) can present with convulsive movements. Misdiagnosed as seizures may delay the reperfusion therapy for acute BAO. In this study, we have summarized the clinical features and possible mechanisms of BAO presenting with convulsive movements.Methods: We performed an Institutional Review Board-approved institutional database query from 2015 to 2020 and a literature search of the online database PubMed. Clinical data were collected and analyzed.Results: In total, 14 patients with acute BAO presented with convulsions. There were 10 men and 4 women, with a mean age of 53 (range, 23–77) years. All of these patients had different degrees of impaired consciousness (100.0%, 14/14). Convulsive movements were the initial symptoms in 78.6% (11/14) of patients. Further, 64.3% (9/14) of patients presented with paralysis or cranial nerve abnormalities, and 85.7% (12/14) of patients were treated with reperfusion therapy (thrombolysis, 35.7% [5/14]; endovascular thrombectomy, 64.3% [9/14]). The BAO etiology and mechanism were related to embolism, vessel dissections, and severe stenosis of the right vertebral artery in 57.1% (8/14), 21.4% (3/14), and 7.1% (1/14) of patients, respectively; they were undefined in 14.3% (2/14) of patients. Moreover, 42.9% (6/14) of patients had a 90-day modified Rankin Scale score of 0–2, and the mortality rate was 21.4% (3/14).Conclusions: Acute BAO, especially that related to embolism or vessel dissection, may present with convulsive movements. Acute BAO is a devastating, but treatable disease if diagnosed in time. Considering the possibility of BAO is important when dealing with patients presenting with acute-onset convulsive movements. Prompt diagnosis and reperfusion therapy may help achieve a better prognosis.

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The history of basilar artery occlusion: when art aids science

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20180030 ◽

2018 ◽

Vol 76 (5) ◽

pp. 355-357

Author(s):

Francisco Antunes Dias ◽

Daniel Giansante Abud ◽

Octavio Marques Pontes-Neto

Keyword(s):

Basilar Artery ◽

Rare Condition ◽

Reperfusion Therapy ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

High Morbidity ◽

Medical Sciences ◽

Randomized Controlled ◽

History Of ◽

The Impact

ABSTRACT Basilar artery occlusion (BAO) ischemic stroke is a relatively rare condition with high morbidity and mortality rates. To date, the best acute reperfusion therapy for BAO has still not been established, mainly due to the lack of randomized controlled trials in this field. In this article, we review the history of BAO diagnosis and treatment, and the impact of modern technological resources on the clinical evolution and prognosis of BAO over time. Furthermore, we describe historical events and nonmedical literature descriptions related to BAO. We conclude that BAO is a singular example of how art may help medical sciences with accurate descriptions of medical conditions.

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A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

Case Reports in Emergency Medicine ◽

10.1155/2014/706147 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Katleen Devue ◽

Annemie Van Ingelgem ◽

Katrien De Keukeleire ◽

Marc De Leeuw

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Vertebral Artery Dissection ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Minor Trauma ◽

Systemic Thrombolysis ◽

The Right

This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

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Management challenge of basilar artery occlusion in SUS: Case report

10.5327/1516-3180.151 ◽

2021 ◽

Author(s):

Isadora Santos Ferreira ◽

Mauricio Elias Nunes da Silva ◽

Liz Barros Rebouças ◽

Rafael Bernhart Carra ◽

Rene de Araújo Gleizer ◽

...

Keyword(s):

Case Report ◽

Basilar Artery ◽

Intravenous Thrombolysis ◽

Tertiary Hospital ◽

Artery Occlusion ◽

Neurological Deficits ◽

Basilar Artery Occlusion ◽

High Morbidity ◽

Basilar Artery Thrombosis ◽

The Right

Context: Stroke caused by basilar artery occlusion is rare, corresponding to 1% of strokes. There is no consensus in the literature on the ideal management of this disease at acute phase. However, mechanical thrombectomy may be a viable treatment option. Case report: 68-year-old female, with no comorbidities, admitted to a secondary hospital 14h after headache, dizziness, vomiting and difficulty walking. She was disoriented, with severe dysarthria and dysphonia, horizontal and vertical ophthalmoparesis and pronation of the right upper limb (NIHSS: 4). Cranial tomography was normal and cranial angiotomography showed a basilar artery thrombosis. Patient was out of the window for intravenous thrombolysis and our hospital did not have another possibility of treatment. Due to high morbidity and mortality, also the possibility of neurological deterioration, medical contact was made with a tertiary hospital with hemodynamic service. During patient transference, she evolved with decreased level of consciousness, aphasia and tetraparesis (NIHSS: 18). Upon arrival at the hospital, a thrombectomy was performed due to an important clinical-radiological mismatch, 19 hours within symptoms onset and 3 hours after neurological worsening. After discharge, patient walked with assistance and physical examination showed a significant improvement in neurological deficits (NIHSS: 6). Conclusions: This case demonstrates the importance of engaging Brazil’s public health system in the management of acute ischemic stroke, especially in challenging cases such as basilar artery occlusion. This patient was the first admitted to our hospital to perform a thrombectomy after effective transference for a tertiary hospital and staff engagement of both hospitals.

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Aggressive Endovascular Reperfusion Therapy for Acute Basilar Artery Occlusion

Japanese Journal of Neurosurgery ◽

10.7887/jcns.20.678 ◽

2011 ◽

Vol 20 (9) ◽

pp. 678-685

Author(s):

Yoshitaka Tanaka ◽

Shinichi Yoshimura ◽

Yusuke Egashira ◽

Kiyofumi Yamada ◽

Yukiko Enomoto ◽

...

Keyword(s):

Basilar Artery ◽

Reperfusion Therapy ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Predicting outcomes after acute reperfusion therapy for basilar artery occlusion

European Journal of Neurology ◽

10.1111/ene.14406 ◽

2020 ◽

Vol 27 (11) ◽

pp. 2176-2184

Author(s):

A. P. Jadhav ◽

S. M. Desai ◽

D. M. Panczykowski ◽

S. Rangaraju ◽

D. Campbell ◽

...

Keyword(s):

Basilar Artery ◽

Reperfusion Therapy ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Case Report: Four Early Recurrent Basilar Artery Occlusions Successfully Treated With Mechanical Thrombectomy and Subsequent Vertebral Artery Coil Occlusion

Frontiers in Neurology ◽

10.3389/fneur.2021.698488 ◽

2021 ◽

Vol 12 ◽

Author(s):

Stefan L. Leber ◽

Simon Fandler-Höfler ◽

Markus Kneihsl ◽

Michael Augustin ◽

Hannes Deutschmann ◽

...

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Neurological Deficits ◽

Basilar Artery Occlusion ◽

Stroke Work ◽

Cerebrovascular Events ◽

Coil Occlusion ◽

The Right

We present the case of a middle-aged patient who had four recurrent acute basilar artery occlusions over a period of 3 months, each time successfully treated with mechanical thrombectomy. Extensive stroke work-up showed no obvious stroke etiology aside from a dysplastic right vertebral artery with multifocal stenoses. Treatment with different antiplatelet and anticoagulant regimes did not prevent basilar artery occlusion recurrence. Therefore, transarterial coil occlusion of the V4-segment of the right vertebral artery was performed as ultima ratio without complications. At final discharge, the patient had no persistent neurological deficits. No further cerebrovascular events occurred over a 12-month follow-up period.

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MULTIMODAL REPERFUSION THERAPY IN PATIENTS WITH ACUTE BASILAR ARTERY OCCLUSION

Neurosurgery ◽

10.1227/01.neu.0000350862.35963.49 ◽

2009 ◽

Vol 65 (3) ◽

pp. 548-553 ◽

Cited By ~ 14

Author(s):

Guy Raphaeli ◽

Roni Eichel ◽

Tamir Ben-Hur ◽

Ronen R. Leker ◽

Jose E. Cohen

Keyword(s):

Prognostic Factors ◽

Scale Score ◽

Basilar Artery ◽

Reperfusion Therapy ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Collateral Flow ◽

Modified Rankin Scale ◽

Good Outcome ◽

Poor Outcome

Abstract OBJECTIVE Multimodal reperfusion therapy (MMRT) has been advocated for the treatment of acute basilar artery occlusion (ABAO). We aimed to identify prognostic factors in patients with ABAO who underwent MMRT. METHODS Clinical and radiological data from consecutive ABAO patients were analyzed. All patients underwent MMRT on an emergency basis. Stroke subtypes were categorized according to TOAST (Trial of ORG 10172 in Acute Stroke Treatment) criteria. Good outcome was defined as a modified Rankin Scale score of 3 or less and poor outcome as a score of 4 or more at 30 days poststroke. RESULTS Twenty-four patients were included (18 men, 6 women) with a mean age of 54.7 years (age range, 26–70 years). Six patients died (25%), and 8 of the surviving 18 patients (44%) achieved a modified Rankin Scale score of 3 or less at 30 days. We could not identify any clinical or radiological variables that were associated with a greater likelihood of good or poor outcome at 30 days other than the presence of good collateral circulation, which was associated with better outcome on univariate analysis. CONCLUSION MMRT resulted in high survival and good outcome rates. We could not identify prognostic factors in patients with ABAO treated with MMRT other than the presence of collateral flow. Our results imply that patients should not be excluded from treatment based on clinical or radiological parameters, and that all patients with ABAO should be given the chance to benefit from therapy.

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