vertebrobasilar stroke

Etiology

• cardiovascular disease, cerebrovascular disease
  • embolism, embolic stroke (largely from heart) 40%
  • large artery disease 32%, arteritis, giant cell arteritis
  • penetrating artery disease 14%
• chiropractic manipulation or hyperextension of the neck

Pathology

• vascular occlusive lesions
  • extracranial vertebral artery 32%
  • intracranial vertebral artery 22%
  • basilar artery 30%
• symptoms attributable to ischemia of:
  • medulla, pons, midbrain, cerebellum, thalamus, occipital cortex
• supplied by:
  • posterior inferior cerebellar artery
  • anterior inferior cerebellar artery
  • superior cerebellar artery
  • posterior cerebral artery

Clinical manifestations

• dysarthria
• vertigo
  • 20% of patients present with isolated vertigo
• ataxia
• diplopia
• visual field loss
• perioral paresthesias
• acute confusional state
• profound general weakness
• focal neurologic signs
• hypertensive urgency -> hypertensive crisis
• gaze-evoked nystagmus
• head-thrust test negative

Complications

• brainstem herniation

Differential diagnosis

• vertebral artery dissection

Management

• see ischemic stroke
• lower blood pressure with labetalol
• thrombolysis with alteplase for vertebrobasilar stroke within 4.5-20 hours with better functional outcomes than standard management

Prognosis:

• 30 day morbidity & mortality
  • 4% mortality
  • 18% major disability
  • 51% minor disability
  • 28% without disability
• poor outcomes associated with embolism
  • 29% of embolic strokes
  • 14% of large artery strokes
  • 13% of penetrating artery strokes
• poor outcomes associated with basilar artery lesions

More general terms

• ischemic stroke

Additional terms

• vertebrobasilar disease
• vertebrobasilar system