title: Basilar artery dissection.
abstract: OBJECTIVE
  Little is understood about the clinical manifestations of basilar artery (BA) dissections, which can present with subarachnoid hemorrhage (SAH), brainstem compression, or ischemia. In any instance, the prognosis seems poorer than that for vertebral artery (VA) dissection. The authors analyzed clinical presentations and radiological features of BA dissection with and without rupture.
  
  
  METHODS
  Between 1998 and 2003, the authors treated 10 patients (eight men and two women, ranging in age from 32-78 years; mean age 54 years) with BA dissection. Diagnosis was based on clinical and radiological findings, including those from magnetic resonance imaging and cerebral angiography studies. Of the 10 patients, five had impaired consciousness at disease onset. Among four patients presenting with SAH, two were treated conservatively and had fair outcomes without recurrent hemorrhage. The other two patients with SAH were treated using unilateral endovascular VA occlusion, but one of them subsequently suffered fatal rebleeding. A fifth patient presented with progressive signs of a mass involving the brainstem, whereas the remaining five patients showed brainstem ischemia; all were treated conservatively. Four patients could not return to their previous daily activities.
  
  
  CONCLUSIONS
  Basilar artery dissections are rare lesions associated with significant morbidity and death. The natural course of and the treatment options for BA dissection differ considerably from those for VA dissections. Management of these lesions is controversial and difficult, and requires particular care.
authors.affiliation: Department of Neurosurgery, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan. yhyoshi@dokkyomed.ac.jp
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Yoshimoto
authors.forename: Katsumi
authors.initials: K
authors.lastname: Hoya
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Takanori
authors.initials: T
authors.lastname: Uchida
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000628:therapy; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged