Basilar thrombosis
| Classification according to ICD-10 | |
|---|---|
| I65.1 | Closure and stenosis of the basilar artery |
| ICD-10 online (WHO version 2019) | |
The basilar thrombosis is a blood clot in the basilar artery . This leads to a reduced blood flow ( ischemia ) of the brain stem and - depending on the vessel collateral as well as the expansion and localization of the thrombus in the artery - possibly also of the cerebellum and the supply area of the posterior cerebral artery ( arteria cerebri posterior ). It is a life threatening emergency that requires immediate diagnosis and treatment.
causes
- local formation of the blood clot on the floor of pre-existing pathological changes in the basilar artery, as in atherosclerosis
- arterio-arterial embolism
Symptoms
Basically, the basilar thrombosis can trigger the full range of brainstem symptoms, but also cerebellar symptoms and visual disturbances.
- Clouding of consciousness up to a coma
- Double vision
- Difficulty swallowing
- Paralysis of the extremities
- Speech disorders ( dysarthria and dysphonia )
- Nausea and vomiting
- Breathing disorders
- Ataxia
- dizziness
- Nystagmus
- Visual disturbances
Severe basilar thrombosis leads to the symptoms of locked-in syndrome .
Diagnosis
After the clinical suspected diagnosis of a basilar thrombosis has been made, it must be immediately verified or refuted by imaging. In addition to a representation of the basal cerebral arteries, which shows whether they are pervious or not, it is also necessary to represent the brain itself in a way that allows differential diagnoses to be excluded and the extent of the tissue that has already died due to the inadequate supply to be determined. Only CT and MRT can be used sensibly (also with regard to availability in emergency situations) . Ischemic areas are captured by MRI at an earlier stage than CT. Immediately afterwards, the vascular imaging is carried out in the CT as CT angiography with the use of contrast medium and in the MRI as MR angiography , which usually works without contrast medium.
Differential diagnoses
- Primary brain stem hemorrhage
- Focal ischemia in occlusion of a branch supplying the brain stem (ramus ad pontem)
forecast
Without treatment, a basilar thrombosis is progressive and has an extremely high risk of death (95% lethality ). The prognosis can be improved by the lysis therapy, the time up to the therapy is of the highest relevance . In addition, pre-existing vascular collaterals and the cause of the vascular occlusion are also of prognostic importance.
therapy
Only rapid therapy is life-saving for the patient. The heart of the treatment is iv thrombolysis in combination with a mechanical thrombectomy . The local lysis previously practiced is no longer primarily recommended. Depending on the conditions on site, a so-called bridging procedure is used, in which the fibrinolytic drug is given intravenously in smaller hospitals and the patient is transferred as quickly as possible to a larger center with the option of an interventional thrombectomy. The risk of lysis is hemorrhage , especially in newly submerged infarct tissue.
literature
- Basilar artery embolism. Clinical syndrome and neuroradiologic patterns in patients without permanent occlusion of the basilar artery. In: Neurology. 1997 Nov; 49 (5), pp. 1346-1352.
- Endovascular therapy of acute vertebrobasilar occlusion: early treatment onset as the most important factor. In: Cerebrovasc Dis. 2002; 14 (1), pp. 42-50.
- Collateral circulation and outcome after basilar artery thrombolysis. In: AJNR Am J Neuroradiol. 1998 Sep; 19 (8), pp. 1557-1563.
- Aggressive therapy with intravenous abciximab and intra-arterial rtPA and additional PTA / stenting improves clinical outcome in acute vertebrobasilar occlusion: combined local fibrinolysis and intravenous abciximab in acute vertebrobasilar stroke treatment (FAST): results of a multicenter study. In: Stroke. 2005 Jun; 36 (6), pp. 1160-1165. Epub 2005 May 12.
