Topof basilar syndrome
Reading File
Reading File
Quick answer
Top-of-the-basilar syndrome is a posterior-circulation ischemic stroke caused by occlusion of the distal basilar artery, affecting branches to the midbrain, thalami, occipital lobes, and sometimes medial temporal lobes.
Typical features
- Sudden reduced consciousness, confusion, agitation, or coma
- Vertical gaze palsy or abnormal eye movements
- Pupillary abnormalities
- Memory impairment
- Visual loss or cortical blindness, often with visual hallucinations
- Dysarthria, ataxia, or weakness may occur, but motor signs can be less prominent than altered mental state and eye findings
Anatomy involved
- Bilateral paramedian thalami
- Rostral midbrain
- Posterior cerebral artery territories, especially occipital cortex
Common cause
- Embolus lodging at the distal basilar artery, though in-situ thrombosis can occur.
Diagnosis
- Emergency CT/CT angiography initially to exclude hemorrhage and identify large-vessel occlusion.
- MRI with diffusion-weighted imaging is more sensitive for thalamic, midbrain, and posterior circulation infarcts.
Management
This is a stroke emergency. Eligible patients may require IV thrombolysis and/or mechanical thrombectomy as quickly as possible. Any sudden combination of impaired consciousness, new visual symptoms, or abnormal eye movements warrants immediate emergency evaluation.
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