Basilar Artery Stroke

Basilar artery occlusion is a rare, but under-recognised, cause of stroke. This condition has a high mortality and morbidity rate. The basilar artery is formed by the union of the two vertebral arteries and terminates as the posterior cerebral arteries (PCAs). Signs and symptoms will depend on where the occlusion is. Patients frequently will have had preceding posterior circulation TIA symptoms.

There may be:

  • Basilar artery occlusion that can cause severe quadriplegia, coma and the locked-in syndrome
  • A stuttering course of posterior circulation symptoms that finally become progressively disabling. The most characteristic motor manifestation is an asymmetric quadriparesis
Bulbar symptoms

Bulbar symptoms include:

  • Facial weakness
  • Jaw weakness
  • Dysarthria
  • Dysphonia
  • Dysphagia
  • Eye signs: Occlusion of the distal basilar artery is often caused by emboli, and is associated with abnormalities of oculomotor and pupillary function
Diagnosis

CT angiography (CTA) is likely to be the most acutely available brain imaging modality.

Patients presenting to the ED with a reduced level of consciousness are likely to be investigated by CT. However, if the diagnosis is suspected early, a CTA request could be made.

Treatment

These patients have a poor outcome with conservative treatment. Intravenous or preferably intra-arterial thrombolysis or mechanical thrombectomy may be beneficial.