A woman with sudden headache followed by collapse

Occlusive lesions can occur anywhere along the basilar artery and will lead to disruption of vital functions in the brain stem; among the acute stroke syndromes, basilar artery embolisation carries the worst prognosis. 3 The most important sign of basilar artery thrombosis is an altered level of con...

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Bibliographic Details
Published in:BMJ 2009-03, Vol.338 (mar25 2), p.b813-b813
Main Authors: Jones, Daniel A, Walker, Fiona, Chopra, Neha R, Serino, Walter, Huwez, Farhad
Format: Article
Language:English
Subjects:
Adult
Anticoagulants
Blood
Brain Ischemia - complications
Brain Ischemia - diagnosis
Cerebral Hemorrhage - complications
Cerebral Hemorrhage - diagnosis
Coma
Consciousness
Dementia
Embolisms
Fainting
Female
Headache Disorders - etiology
Headaches
Histamine
Humans
Magnetic Resonance Imaging
Medical imaging
NMR
Nuclear magnetic resonance
Rabbits
Shock - etiology
Stroke
Studies
Substance abuse treatment
Thalamus - blood supply
Thrombosis
Tomography
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Summary:Occlusive lesions can occur anywhere along the basilar artery and will lead to disruption of vital functions in the brain stem; among the acute stroke syndromes, basilar artery embolisation carries the worst prognosis. 3 The most important sign of basilar artery thrombosis is an altered level of consciousness-patients may present with coma when the bilateral medial pontine tegmentum is ischaemic. 4 The pontine tegmentum is supplied mostly by arteries that arise from the distal basilar artery, so if the artery remains patent the tegmentum is relatively spared. Learning points Ischaemic stroke in the young has diverse causes, with cardioembolism being the most common It is important to investigate such an incident thoroughly because many causes are treatable and preventable Loss of consciousness indicates brainstem involvement, and basilar artery thrombosis should be considered Basilar artery thrombosis is under-recognised and has an unfavourable prognosis It is important to recognise basilar artery thrombosis early because it can be treated with thrombolysis Transthoracic echocardiography should be performed in all young patients with stroke even if the stroke is haemorrhagic Transoesophageal echocardiography with contrast should be performed if the transthoracic echocardiogram is normal
ISSN:0959-8138
1468-5833
1756-1833
DOI:10.1136/bmj.b813