Top Of Basilar Artery Syndrome Research Articles

A rare case presentation of top of basilar artery syndrome

Top of basilar syndrome occurs due to the thrombotic occlusion of basilar artery. It is very rare in occurrence and constitutes about 1% of all strokes. Clinical manifestations commonly may have the hallmarks of basilar artery occlusion that include dysarthria, visual, oculomotor and behavioural abnormalities with or without significant motor dysfunction and non-specific symptoms like vertigo and headache. Here we report a case of 60year old male who presented with decreased responsiveness and slurring of speech since 2 days and history of vomiting since one day. Neurological examination revealed normal higher mental functions with MMSE score of 28/30, horizontal nystagmus was present, other cranial nerve examination was normal, tone was increased in all the four limbs, Power was 4/5 in all the 4 limbs and Plantar was mute bilaterally. Patient condition deteriorated later and on further evaluation patient was found to have Basilar Artery Occlusion.

Rhinocerebral Mucormycosis with Top of Basilar Artery Syndrome

Our objective is to highlight the varied forms of vascular dissemination of rhinocerebral mucormycosis resulting in ischemic arterial syndromes, especially rare posterior ischemic circulatory strokes, through dissemination of mucormycosis from sphenoid bone to clivus by bony erosion and to the basilar artery, thus causing the top of basilar artery syndrome. We have reported a case of rhinocerebral mucormycosis in an uncontrolled diabetic patient presented to the neurointensive care unit, department of neurology. A 56-year-old male diabetic patient with poorly controlled glycemic levels presented with pansinusitis resulting in rhinocerebral mucormycosis with basilar artery erosion through clivus bone erosion from sphenoid sinus. Mucormycosis is caused by fungi. Mucormycosis is commonly reported in immunocompromised patients such as poorly controlled diabetes mellitus, blood dyscrasias, malnutrition, neutropenia, iron overload, organ transplant, and immunosuppressive therapy. Mucormycosis rises with an increase in incidence of diabetes mellitus and HIV infection leading to immunocompromised status of the patient. In our case, there is invasion to the sphenoid bone and to clivus by bony erosion and to the basilar artery, thus causing the top of basilar artery syndrome, which is very unusual. Mucormycosis has a very fatal rapid progression with varied forms of cerebral dissemination with high mortality; hence early recognition and aggressive treatment are needed to increase the survival rate.

Top of Basilar Artery Syndrome.

A 45 years old male presented in Department of Medicine at the Shree Shayaji General Hospital with sudden onset bilateral ptosis, dilatation of the pupil and paresis of extraocular muscles. There were area of restricted diffusion on diffusion weighted images with corresponding low ADC (Apparent Diffusion Coefficient) value in periaqueductal region, oculomotor nucleus and medial thalami suggestive of acute infract. In MR cerebral angiographic image filling defect is seen in the basilar artery suggestive of thrombosis [Table/Fig-1,​,22,​,3].3]. Top of the Basilar Artery Syndrome is also known as a Rostral Brainstem Infarction. It is due to the thromboembolic occlusion of the top of the basilar artery. Risk factors for the thrombosis are hypertension [1], diabetes mellitus [2], obesity [2], hyperhomocystinemia [3], and excessive alcohol intake. It may be secondary to the cardiogenic emboli like mural thrombi in myocardial infarction and atrial fibrillations or valvular thrombi in infective endocarditic and valvular heart disease. Hypercoaguable states like antiphospholipid antibodies [4], protein C deficiency [4], protein S deficiency [4] may also leads to the thrombotic events. Small vessel vaculities in sickle cell disease may be associated with it. Bilateral tha lamic ischemia occurs due to occlusion of perforator vessels. Clinically patient develops symptoms like visual and oculomotor deficits and behavioral abnormalities. However, motor dysfunction is often absent [5]. CT angiography, MR angiography and catheter angiographic are the imaging modality use to confirm the finding and demonstrate a filling defect [6]. Prognosis in patient with bilateral ocular palsy is poor. [Table/Fig-1a,b]: Axial section of diffusion weighted MR image shows (A) area of restricted diffusion in oculomotor nuclei region in midbrain (open white arrow) (B) area of restricted diffusion in bilateral medial thalami (open white arrow) [Table/Fig-2a,b]: Axial section of Apparent Diffusion map shows (A) corresponding low ADC value in oculomotor nuclei region in medulla (black solid arrow) (B) in bilateral medial thalami (solid white arrow) [Table/Fig-3a,b]: MR angiographic images shows filling defect in the basilar artery suggestive of thrombosis Top of the basilar artery syndrome is occurring due to thrombotic occlusion of the basilar artery. Patient presented with visual and oculomotor deficit and behaviour abnormalities. MR angiography demonstrate filling defect in the basilar artery.