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Symptoms and Signs in Early Vertebrobasilar Territory Stroke

  • L. R. Caplan
Conference paper

Abstract

Within the posterior circulation, as in the anterior circulation, most acute brain infarcts are caused by thrombi within intracranial arteries. These thrombi can form in situ (“thrombosis”) within the intracranial arteries or represent emboli that have arisen from the heart, aorta, or proximal cervicocranial arteries. The possible exception is infarction in the distribution of single penetrating or circumferential branch arteries; such infarctions are often caused by luminal compromise by plaques and changes within the vessel walls [1]. Individuals of Japanese, Chinese, and Thai origin and African-Americans are more likely to have occlusive changes within intracranial posterior circulation arteries and branches, especially the distal basilar artery and the posterior inferior cerebellar arteries (PICAs), than are comparable Caucasian populations [2,3]. Thrombolysis is likely to have a different effectiveness in patients who have emboli to previously normal intracranial arteries (the entire intraluminal lesion representing a thrombus) compared to those patients that have important prior luminal narrowing caused by plaque (the occlusive lesion representing plaque plus thrombus). In this chapter, I concentrate on reviewing the clinical symptoms and signs in patients with acute occlusions of the intracranial vertebral arteries (ICVAs) and the basilar artery (BA), because they are the patients in whom thrombolysis is most likely to be feasible and therapeutically successful, and contrast the findings in patients with ICVA and BA occlusion to those found in patients with atheromatous branch disease and lacunar infarction.

Keywords

Basilar Artery Posterior Inferior Cerebellar Artery Contralateral Limb Sixth Cranial Nerve Palsy Basilar Artery Occlusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Caplan LR (1989) Intracranial branch atheromatous disease. Neurology 39: 1246–1250PubMedGoogle Scholar
  2. 2.
    Gorelick PB, Caplan LR, Hier DB, Langenberg P, Pessin MS, Biller J (1985) Racial differences in the distribution of posterior circulation occlusive disease. Stroke 16: 785–790PubMedCrossRefGoogle Scholar
  3. 3.
    Leung SY, Ng TH, Yuen ST, Lauder IJ, Ho FC (1993) Pattern of cerebral atherosclerosis in Hong Kong Chinese. Severity in intracranial and extracranial vessels. Stroke 24: 779–786PubMedCrossRefGoogle Scholar
  4. 4.
    Chaves CJ, Caplan LR, Chung C-S, Tapia J, Amarenco P, Teal P, Wityk R, Estol C, Tettenborn B, Rosengart A, Vemmos K, DeWitt LD, Pessin MS (1994) Cerebellar infarcts in the New England Medical Center posterior circulation registry. Neurology 44: 1385–1390PubMedGoogle Scholar
  5. 5.
    Chaves C, Caplan LR, Chung C-S, Amarenco P (1994) Cerebellar infarcts. In: Appel S (ed) Current neurology, vol 14. Mosby, St Louis, pp 143–177Google Scholar
  6. 6.
    Kase CS, Norrving B, Levine SR, Babikian VL, Chodosh EH, Wolf PA, Welsh KMA (1993) Cerebellar infarction. Clinical and anatomical observations in 66 cases. Stroke 24: 76–83PubMedCrossRefGoogle Scholar
  7. 7.
    Caplan LR, Pessin MS, Mohr JP (1992) Vertebrobasilar occlusive disease. In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM (eds) Stroke: Pathophysiology, diagnosis and management, 2nd edn. Churchill Livingstone, New York, pp 443–515Google Scholar
  8. 8.
    Currier R, Giles C, Dejong R (1961) Some comments on Wallenberg’s lateral medullary syndrome. Neurology 12: 778–791Google Scholar
  9. 9.
    Bogousslaysky J, Khurana R, Deruaz JP, Hornung JP, Regli F, Janzer R, Perret C (1990) Respiratory failure and unilateral caudal brainstem infarction. Ann Neurol 28: 668–673CrossRefGoogle Scholar
  10. 10.
    Duffy P, Jacobs G (1958) Clinical and pathological findings in vertebral artery thrombosis. Neurology 8: 862–869PubMedGoogle Scholar
  11. 11.
    Caplan LR (1993) Stroke. A clinical approach, 2nd edn. Butterworth, Boston, p 256Google Scholar
  12. 12.
    Pierrot-Deseilligny C, Chain F, Serdaru M, Gray F, Lhermitte F (1981) The “one-and-a half” syndrome. Brain 194: 665–699CrossRefGoogle Scholar
  13. 13.
    Caplan LR (1980) Top of the basilar syndrome. Neurology 30: 72–79PubMedGoogle Scholar
  14. 14.
    Mehler MF (1988) The neuro-opthalmologic spectrum of the rostral basilar artery syndrome. Arch Neurol 45: 966–971PubMedCrossRefGoogle Scholar
  15. 15.
    Caplan LR (1995) Posterior cerebral artery territory ischemia. In: Bogousslaysky J, Caplan LR (eds) Stroke syndromes. Cambridge University Press, London, pp 290–299Google Scholar
  16. 16.
    Pessin MS, Gorelick PB, Kwan E, Caplan LR (1987) Basilar artery stenosis middle and distal segments. Neurology 37: 1742–1746PubMedGoogle Scholar
  17. 17.
    Caplan LR (1983) Bilateral distal vertebral artery occlusion. Neurology 33: 552–558PubMedGoogle Scholar
  18. 18.
    Pullicino PM (1993) The course and territories of cerebral small arteries. In: Pullicino PM, Caplan LR, Hommel M (eds) Advances in neurology, vol 62. Cerebral small artery disease. Raven, New York, pp 11–72Google Scholar
  19. 19.
    Bogousslaysky J, Caplan LR (1993) Vertebrobasilar occlusive disease. Review of selected aspects: 3 thalamic infarcts. Cerebrovasc Dis 3: 193–205CrossRefGoogle Scholar
  20. 20.
    Caplan LR, DeWitt LD, Pessin MS, Gorelick PB, Adelman LS (1988) Lateral thalamic infarcts. Arch Neurol 45: 959–964PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1995

Authors and Affiliations

  • L. R. Caplan
    • 1
  1. 1.Department of NeurologyTufts-New England Medical CenterBostonUSA

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