Magnetic resonance imaging in basilar artery occlusion.
BACKGROUND
Acute basilar artery occlusion has particularly high mortality and morbidity.


OBJECTIVE
To determine the potential utility of advanced magnetic resonance imaging (MRI) methods, including diffusion-weighted imaging, for the early management of patients with basilar artery thrombosis.


METHODS
Case series.


METHODS
Institute of Neuroradiology and Department of Neurology, Johann Wolfgang Goethe University, Frankfurt, Germany.


METHODS
In 4 patients with occlusion of the basilar artery, MRI was performed, including T2-weighted and diffusion-weighted imaging (DWI) sequences and magnetic resonance angiography (MRA) in the short-term phase (<12 hours). Three patients underwent intra-arterial thrombolysis. Clinical outcome was obtained 10 days after symptom onset.


RESULTS
The MRA was performed 3.5 to 11.5 hours after symptom onset and showed basilar artery occlusion in all cases. The DWI revealed different patterns of ischemic lesions. In 2 patients, no or only small lesions could be identified; the remaining showed multiple and large lesions within the posterior circulation territory. Initial clinical status was severely impaired in all cases (Rankin scale score, 4-5). Thrombolysis was initiated in 3 patients, leading to successful recanalization in 2. Clinical outcome was favorable in the 2 patients with small DWI lesions and successful reperfusion (Rankin scale score, 2), whereas it was worse in those with large DWI lesions and persisting occlusion (death, persisting coma).


CONCLUSIONS
In critically ill patients with acute basilar occlusion, the extent of DWI lesion involvement can be highly variable. Small DWI lesions seem to be associated with a favorable outcome if reperfusion is achieved with thrombolysis. This could potentially be the case independent of time from symptom onset.
du Mesnil de Rochemont
Richard
R
Institute of Neuroradiology, University of Frankfurt, Schleusenweg 2-16, 60528 Frankfurt, Germany. Mesnil@em.uni-frankfurt.de
Neumann-Haefelin
Tobias
T
Berkefeld
Joachim
J
Sitzer
Matthias
M
Lanfermann
Heinrich
H
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000175:diagnosis* / Q000188:drug therapy; D001488:Basilar Artery / Q000473:pathology*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D010960:Plasminogen Activators / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator