'Bats below the bridge': is a potentially treatable neurovascular disorder being underdiagnosed in accident and emergency departments?

Basilar artery thrombosis

“…However, even when they are, clinical and many radiological modalities are often inadequate assessments of this vascular area 4,6,9,12 . The classical clinical triad 15 is said to be ‘long tract signs, impaired LOC and complex ocular signs.…”

“…As basilar artery thrombosis may be an evolving process, there may be a constellation of changing and fluctuating signs that relate to these tracts (Table 3). Consequently, the signs of complete occlusion may be absent 15 …”

“…Basilar artery thrombosis is universally recognized as a condition that is difficult to diagnose clinically, with many patients being young and previously well with fluctuating signs that do not fit common neurological patterns. 5,[11][12][13][14][15][16] This is especially so if posterior circulation abnormalities are not considered. However, even when they are, clinical and many radiological modalities are often inadequate assessments of this vascular area.…”

“…Consequently, the signs of complete occlusion may be absent. 15 In 80% of cases, BAT develops as a result of atheroma formation in the distal vertebral and proximal basilar arteries. 7,11,12,15,[17][18][19][20] In the remaining 20%, BAT develops in the distal basilar artery and is almost exclusively due to embolic events.…”

“…15 In 80% of cases, BAT develops as a result of atheroma formation in the distal vertebral and proximal basilar arteries. 7,11,12,15,[17][18][19][20] In the remaining 20%, BAT develops in the distal basilar artery and is almost exclusively due to embolic events. 7,17,21 However, thrombosis has been associated with other conditions, such as cervical trauma, 8,18,22 arteritis, 26,27 infection, 24 electrical injury including electroconvulsive therapy, 25 basilar artery aneurysms, 18 hypercoaguable states, 8 recreational drug use (cocaine) and the OCP in women.…”