eMedicine Specialties > Neurology > Neuro-vascular Diseases

Basilar Artery Thrombosis: Follow-up

Author: Salvador Cruz-Flores, MD, MPH, Professor of Neurology, Director of Souers Stroke Institute, Department of Neurology and Psychiatry, St Louis University School of Medicine; Director, Mid-America Stroke Network and Neuroscience Critical Care Unit, St Louis University Hospital
Coauthor(s): Sombat Muengtaweepongsa, MD, Faculty, Department of Neurology, Thammasat University, Pathumthani, Thailand
Contributor Information and Disclosures

Updated: Aug 18, 2009

Follow-up

Further Inpatient Care

  • Rehabilitation: Patients with brainstem, cerebellar, diencephalic, or occipital infarcts secondary to basilar artery occlusion have a significant degree of disability because of weakness, ataxia, swallowing difficulties, other cranial neuropathies, or a combination of all.
    • Patients need training on balance and gait.
    • Patients with dysphagia are at a significant risk for aspiration and pneumonia. Evaluation of these patients should be thorough and should include videofluoroscopy with modified barium swallow to assess for silent aspiration. Interventions for prevention of aspiration include compensatory strategies that include oromotor exercises; postural changes while swallowing; and facilitative strategies that include modification of bolus consistency, volume, and delivery.
    • Using a patch on one eye or prisms can help diplopia.

Further Outpatient Care

  • These patients need strict risk factor control to decrease the risk of stroke recurrence.

Deterrence/Prevention

  • The prevention strategy depends on the cause of the basilar artery occlusion.
    • Patients with a definite cardioembolic source, such as atrial fibrillation, should be treated with warfarin to maintain an INR between 2 and 3.
    • The treatment of patients with basilar artery and vertebral artery atherosclerosis includes antiplatelet agents and risk factor control.
    • No definite indication currently exists for long-term anticoagulation in patients with noncardioembolic stroke.

Complications

Prognosis

  • Patients with acute basilar artery occlusion have a mortality rate greater than 85%, although the mortality rate may be as low as 40% in patients with recanalization.
  • Good functional outcomes can be expected in as many as 24-35% of patients treated with intravenous or intra-arterial thrombolysis, respectively.
  • For symptomatic patients who survive, the risk of recurrent stroke is 10-15%.

Patient Education

 


More on Basilar Artery Thrombosis

Overview: Basilar Artery Thrombosis
Differential Diagnoses & Workup: Basilar Artery Thrombosis
Treatment & Medication: Basilar Artery Thrombosis
Follow-up: Basilar Artery Thrombosis
Multimedia: Basilar Artery Thrombosis
References
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Further Reading

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Keywords

basilar artery occlusion, anterior inferior cerebellar artery, AICA, posterior cerebral artery, PCA, atherothrombosis, embolism, arterial dissection, atherosclerotic occlusion, vertebrobasilar insufficiency, VBI, stroke, hypertension, partial basilar artery occlusion, intravenous thrombolysis, atherosclerotic basilar artery stenosis, occlusion of the distal basilar artery, pontine ischemia, locked-in syndrome, top-of-the-basilar syndrome, stroke, neck injury, chiropractic manipulation, atrial fibrillation.

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Contributor Information and Disclosures

Author

Salvador Cruz-Flores, MD, MPH, Professor of Neurology, Director of Souers Stroke Institute, Department of Neurology and Psychiatry, St Louis University School of Medicine; Director, Mid-America Stroke Network and Neuroscience Critical Care Unit, St Louis University Hospital
Salvador Cruz-Flores, MD, MPH is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Neurology, American College of Physicians, American Heart Association, American Medical Association, American Society of Neuroimaging, American Stroke Association, National Stroke Association, Neurocritical Care Society, and Society of Critical Care Medicine
Disclosure: NovoNordisk Grant/research funds clinical trial; Photothera INC Grant/research funds clinical trial; IMRX therapeutics Inc Grant/research funds clinical trial; Coaxia Inc Grant/research funds clinical trial; Neurobiological Technologies Inc Grant/research funds clinical trial

Coauthor(s)

Sombat Muengtaweepongsa, MD, Faculty, Department of Neurology, Thammasat University, Pathumthani, Thailand
Disclosure: Nothing to disclose.

Medical Editor

Draga Jichici, BSc, MD, FRCP, Associate Clinical Professor, Department of Medicine, Division of Neurology and Critical Care Medicine, McMaster University, Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health & Science University; Associate Director, Oregon Stroke Center
Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association
Disclosure: Co-Axia Consulting fee Review panel membership; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Concentric Medical Consulting fee Review panel membership; Abbott Consulting fee Consulting; Sanofi  Consulting

 
 
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