guayoman
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A variety of different presentations of basilar artery stroke may occur depending upon the nature of the occlusion and the specific site of the artery affected.
Prodromal features are common and must be acted upon quickly since they can often be treated effectively. Occlusion of the main arterial trunk is rapidly fatal.
Occlusion of specific branches result in well characterised syndromes and are dealt with in relation to the particular artery involved.
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| guayoman
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Clinically, basilar artery stroke features are divided into: Prodromal symptoms - stuttering brainstem stroke - including:
- transient diplopia visual field loss intermittent memory loss brain stem symptoms e.g. vertigo, ataxia, paresis, paraesthesia
Following occlusion there is:
- reduced level of conscious progressing to coma bilateral motor and sensory loss - often in all limbs cerebellar signs cranial nerve palsies - dependent upon the precise level of occlusion
Occlusion of the basilar artery at it's origin produces lateral midbrain, thalamic, occipital and medial temporal lobe infarction.
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| guayoman
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'Locked in' syndrome is the result of a bilateral lesion in the medulla due to occlusion of the penetrating midline branches of the basilar artery.
Characteristically, the patient is unable to talk, swallow or move the limbs despite being conscious and alert.
Some facial and eye movements are preserved permitting elsensation is retained but discriminatory sensation in the limbs is lost due to damage to the medial lemniscus.
Spinothalamic sensation is retained but discriminatory sensation in the limbs is lost due to damage to the medial lemniscus.
The prognosis is poor.
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| guayoman
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The basilar artery supplies the brainstem from medulla upwards.
It is formed by the union of the two vertebral arteries. It runs forwards and divides into posterior cerebral arteries and posterior communicating arteries which run forward to join the anterior circulation of the circle of Willis.
It's principal branches are:
- posterior cerebral arteries long circumflex branches - superior cerebellar and anterior inferior cerebellar arteries paramedian branches
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| guayoman
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This is all from www.gpnotebook.co.uk Pretty complete and easy to understand.
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| Jinx
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isnt locked in syn due to a pontine lesion??
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| guayoman
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Yes Jinx. You are quite the observer. THis extract is from www.emedicine.com
Locked in syndrome is caused by infarction of the basis pontis secondary to occlusive disease of the proximal to midle segments of the basilar artery, which leads to quadriplegia.
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| guayoman
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The other post was from a british site. Maybe they ment medulla as the whole that includes pons and midbrain.
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| MAZI
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I think that locked in syn is due to occlusion of perforating branch of basilary artery
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