J Korean Neurol Assoc.  1994 Sep;12(3):448-457.

Top of the Basilar Syndrome: Clinical and Radiological Characteristics

• Kim BM
• Roh JK
• Park SH

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.

MeSH Terms

Arteries
Brain Stem Infarctions*
Cerebellum
Consciousness
Dementia
Humans
Infarction
Intelligence
Magnetic Resonance Imaging
Mesencephalon
Occipital Lobe
Persistent Vegetative State
Pons
Posterior Cerebral Artery
Stroke
Thalamus