Clinical Syndromes Large Vessel Occlusion

BASILAR ARTERY OCCLUSION Anatomy

Basilar Posterior artery communicating artery

Posterior cerebral a.

Superior cerebellar a.

----Pontine branches

.--Internal auditory a.

— Anterior inferior cerebellar artery

Vertebral artery

Anterior spinal artery

Posterior inferior cerebellar artery

The basilar artery supplies the brain stem from medulla upwards and divides eventually into posterior cerebral arteries as well as posterior communicating arteries which run forward to join the anterior circulation (circle of Willis). Branches can be classified into:

1. Posterior cerebral arteries

2. Long circumflex branches

3. Paramedian branches.

Clinical features

Prodromal symptoms are common and may take the form of diplopia, visual field loss, intermittent memory disturbance and a whole constellation of other brain stem symptoms:

- vertigo

- ataxia

- paresis

- paraesthesia

The complete basilar syndrome following occlusion consists of:

- impairment of consciousness -» coma

- bilateral motor and sensory dysfunction

- cerebellar signs

- cranial nerve signs indicative of the level of occlusion.

The clinical picture is variable. Occasionally basilar thrombosis is an incidental finding at autopsy.

' Top of basilar' occlusion-. This results in lateral midbrain, thalamic, occipital and medial temporal lobe infarction. Abnormal movements (hemiballismus) are associated with visual loss, pupillary abnormalities, gaze palsies, impaired conscious level and disturbances of behaviour.

Paramedian perforating vessel occlusion gives rise to the 'LOCKED-IN' SYNDROME (page 251) and LACUNAR infarction (page 252).

POSTERIOR CEREBRAL ARTERY Anatomy

Basilar ... artery

Calcarine branch

Perforating vessels

Posterior cerebral artery

— Occipital branch

Occipital branch i

Temporal branch

Cerebral Temporal Calcarine peduncle branch branch

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