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Richard du Mesnil de Rochemont, MD; Tobias Neumann-Haefelin, MD; Joachim Berkefeld, MD; Matthias Sitzer, MD; Heinrich Lanfermann, MD

Arch Neurol. 2002;59:398-402.

Context  Acute basilar artery occlusion has particularly high mortality and morbidity.

Objective  To determine the potential utility of advanced magnetic resonance imaging (MRI) methods, including diffusion-weighted imaging, for the early management of patients with basilar artery thrombosis.

Design  Case series.

Setting  Institute of Neuroradiology and Department of Neurology, Johann Wolfgang Goethe University, Frankfurt, Germany.

Patients  In 4 patients with occlusion of the basilar artery, MRI was performed, including T2-weighted and diffusion-weighted imaging (DWI) sequences and magnetic resonance angiography (MRA) in the short-term phase (<12 hours). Three patients underwent intra-arterial thrombolysis. Clinical outcome was obtained 10 days after symptom onset.

Results  The MRA was performed 3.5 to 11.5 hours after symptom onset and showed basilar artery occlusion in all cases. The DWI revealed different patterns of ischemic lesions. In 2 patients, no or only small lesions could be identified; the remaining showed multiple and large lesions within the posterior circulation territory. Initial clinical status was severely impaired in all cases (Rankin scale score, 4-5). Thrombolysis was initiated in 3 patients, leading to successful recanalization in 2. Clinical outcome was favorable in the 2 patients with small DWI lesions and successful reperfusion (Rankin scale score, 2), whereas it was worse in those with large DWI lesions and persisting occlusion (death, persisting coma).

Conclusions  In critically ill patients with acute basilar occlusion, the extent of DWI lesion involvement can be highly variable. Small DWI lesions seem to be associated with a favorable outcome if reperfusion is achieved with thrombolysis. This could potentially be the case independent of time from symptom onset.

From the Institute of Neuroradiology (Drs du Mesnil de Rochemont, Berkefeld, and Lanfermann) and Department of Neurology (Drs Neumann-Haefelin and Sitzer), Johann Wolfgang Goethe University, Frankfurt, Germany.

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