Neurological Complications and Aspects of Basilar Artery Occlusive Disease

Idicula, Titto; Joseph, L

doi:10.1097/01.nrl.0000257849.31167.4f

Cited by 14 publications

(7 citation statements)

References 39 publications

(16 reference statements)

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Section: Discussionsupporting

confidence: 91%

“…LiS is one of the most feared consequences of vertebrobasilar disease, occurring in 14.4% of all patients with BAO in the present study, which is consistent with the findings of a previous report of 10-15%. 14 The prognosis of patients diagnosed with LiS varies. Earlier literature, primarily relying on autopsy findings, reported that long-term survival without neurological recovery was rare.…”

Section: Discussionmentioning

confidence: 99%

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Locked-in syndrome responding to endovascular treatment

Song

Huang

et al. 2022

J NeuroIntervent Surg

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BackgroundLocked-in syndrome (LiS) is a rare and devastating condition in patients with acute basilar artery occlusion. However, the benefits of endovascular treatment (EVT) for LiS remain unclear.ObjectiveTo assess the outcomes associated with EVT and identify the factors associated with outcomes of LiS.MethodsWe used the data of the Endovascular Treatment for Acute Basilar Artery Occlusion Study Registry (BASILAR) from 47 tertiary stroke centers in China. The included patients had LiS and received EVT or standard medical treatment (SMT) alone. The primary outcome was improvement in the modified Rankin Scale (mRS) score at 90 days.ResultsAmong the 120 patients with LiS, 92 (76.7%) received EVT and 28 (23.3%) received SMT. Compared with SMT, EVT was associated with improved mRS score (common OR (cOR)=2.68 (95% CI 1.16 to 6.20); p=0.02) and decreased mortality (aOR=0.35 (95% CI 0.13 to 0.90); p=0.03). Moreover, the benefit of EVT for LiS was sustained for at least 1 year (p=0.008). Higher baseline posterior circulation Alberta Stroke Prognosis Early CT Score (pc-ASPECTS, aOR=2.04 (95% CI 1.34 to 3.10); p<0.001) and absence of pneumonia (aOR=0.26 (95% CI 0.08 to 0.90); p=0.03) were significantly associated with favorable functional outcome at 90 days in patients who received EVT, while lower pc-ASPECTS (aOR=0.52 (95% CI 0.36 to 0.76); p<0.001) was associated with increased 90-day mortality.ConclusionsThis study found that EVT was associated with favorable functional outcomes and decreased mortality among patients with LiS. Baseline pc-ASPECTS and pneumonia were independent predictors of outcomes.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Locked-in syndrome responding to endovascular treatment

Song

Huang

et al. 2022

J NeuroIntervent Surg

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“…4 Vertebral artery dissections (VADs) correspond to 20% of cases of cerebral infarction in patients under 45 years and LIS is the most feared complication, occurring in 10 to 15% of basilar artery occlusions (BAOs). 3,10,11 BAO is a serious condition that presents with 90% mortality in the first 4 months. 3,10 VADs are divided into spontaneous or traumatic, the latter being more common in young patients, younger than 45 years.…”

Section: Discussionmentioning

confidence: 99%

“…8,12 The incidence of traumatic lesion of the vertebral arteries varies on the literature, but may affect 0.5 to 2% of all polytraumatized patients and up to 20% of those with cervicocranial trauma. 8,11,12 Recanalization of acute BAO significantly reduces mortality. Treatment can be made by intravenous or intraarterial thrombolysis, with similar outcomes in terms of survival and resolution of neurological symptoms, or by endovascular therapy.…”

Section: Discussionmentioning

confidence: 99%

Locked-In Syndrome after Trauma—A Rare Case in the Literature

Chaves

Mezadri

Suzuki

et al. 2018

IJNT

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The present report is about a 25-year-old woman who had a motorcycle accident with brain trauma injury. Although she was admitted at another institution disoriented but alert, she progressively evolved to an altered level of consciousness and required orotracheal intubation. She was then transferred to our hospital sedated, and the admission head computed tomography showed signs of posterior fossa ischemia. The angiography demonstrated a vertebral artery dissection with subsequent embolization to the basilar artery, which provoked its complete occlusion. After drug withdrawal, the patient recovered level of consciousness but was aphasic and did not exhibit purpose movements apart from eye blinking, as expected in patients with locked-in syndrome.

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“…The majority of brain stem infarcts are due to basilar artery occlusion (BAO). Locked in syndrome is one of the most feared consequences of vertebrobasilar disease, occurring in 10–15% of all patients with BAO 1. Patients with complete locked in syndrome are unable to move and are only able to communicate by blinking.…”

Section: Introductionmentioning

confidence: 99%

Locked in and out: a case of emerging basilar artery obstruction secondary to vertebral artery dissection thrombolysed with intravenous rt-PA

Al-Raweshidy

Sinha²,

Coward³

et al. 2011

Case Reports

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SummaryThe authors present a case in which intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) potentially saved a young man from locked-in syndrome or life threatening consequences. The patient presented with acute stroke secondary to vertebral artery dissection and was treated with intravenous rt-PA. There were no post thrombolysis complications and the patient left hospital with mild neurological symptoms. Our report suggests that in cases of acute posterior circulation stroke due to arterial dissection, treatment with intravenous thrombolysis is safe, practicable and effective.

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Neurological Complications and Aspects of Basilar Artery Occlusive Disease

Cited by 14 publications

References 39 publications

Locked-in syndrome responding to endovascular treatment

Locked-in syndrome responding to endovascular treatment

Locked-In Syndrome after Trauma—A Rare Case in the Literature

Locked in and out: a case of emerging basilar artery obstruction secondary to vertebral artery dissection thrombolysed with intravenous rt-PA

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