Top of the Basilar Syndrome : Clinical and Radiological ?Characteristics

J Korean Neurol Assoc > Volume 12(3); 1994 > Article

Journal of the Korean Neurological Association 1994;12(3): 448-457.

뇌기저동맥 첨단부 폐쇄증후군의 임상 및 방사선소견

김병모, 노재규,박성호

서울대학교 신경과. 보라매병원 신경과.

Top of the Basilar Syndrome : Clinical and Radiological ?Characteristics

Byung Mo Kim, M.D., Jae Kyu Roh, M.D., Seong Ho Park, M.D.

Department of Neurology, College of Medicine, Seoul National University and Department of Neurology, Boramae City Hospital

Abstract

Clinical and radiological characteristics were studied in twenty-six patients with MRI-supported ""top of the basilar"" syndrome. Transient symptoms of vertebrobasilar artery insufficiency often preceded the eventual stroke in 46% of the patients. By the arbitrary clinical criteria, the patients were divided into embolic (n=16) or nonembolic (n=10) group of the syndrome. The proportion of embolic etiology was roughly higher than that of non-embolic etiology. The clinical manifestations were similar in both goup except fitting the criterial. Final outcomes were as follows : clear consciousness and normal intelligence in 4 (15%), dementia in 7 (27%), locked-in state in 2 (8%), persistent vegetative state in 9 (35%), and death in 4 patients (15%). By the MRI findings, all the patients had the thalamic infarction : bilateral in 24 (92%) and unilateral in 2 (8%). Variable combinations of infratentorial infarction in the midbrain, pons, and cerebellum were seen in most of them (24 cases), while supratentorial infarction in the terrritory of posterior cerebral artery, I.e. in the inferior temporal and/or occipital lobes, was less frequent (58%). The hemorrhagic infarction was very rare (12%). Infarcted areas in the tentative embolic group have more confluent and large infarction whereas those in the non-embolic group (most of them are tentatively thrombotic) show multiple discrete infarctions in the carotid them are tentatively thrombotic) show multiple discrete infarctions in the carotid territories as well as vertebrobasilar territory. The fact that the pattern of infarction in the paramedian thalamus and midbrain is not so different in both group suggests that this territory may be an end artery zone from the branches of basilar top, and that collaterals from the anterior circulation through the posterior communicating arteries usually do not supply this end artery zone.