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Stroke or Transient Ischemic Attacks With Basilar Artery Stenosis or Occlusion
Clinical Patterns and Outcome
G. Devuyst, MD;
J. Bogousslavsky, MD;
R. Meuli, MD;
J. Moncayo, MD;
G. de Freitas, MD;
G. van Melle, PhD
Arch Neurol. 2002;59:567-573.
Background Basilar artery occlusion (BAO) is associated with a high mortality rate,
although cases with spontaneous favorable outcomes have recently been reported,
and basilar artery stenosis (BAS) has received little consideration until
now.
Objective To study the prognostic clinical factors by testing numerous combinations
of admission status characteristics of patients with brain ischemia caused
by BAO or BAS.
Methods We conducted a retrospective review from the Lausanne Stroke Registry
(group 1) of patients with stroke or transient ischemic attack caused by BAS
less than 50% or BAO as diagnosed by magnetic resonance angiography who were
not treated by thrombolysis. Neurologic findings on admission were correlated
with outcomes. We compared clinical patterns associated with poor outcomes
in group 1 with those in patients with stroke who died from BAO or BAS (confirmed
at autopsy) (group 2).
Results Eighty-eight patients were studied. The outcomes of patients with stroke
in group 1 (35/43) was poor (severe disability or death) in 54% of cases.
A statistical analysis revealed that 4 factors—dysarthria, pupillary
disorders, lower cranial nerve involvement, and consciousness disorders on
admission—were strongly (P<.001) associated
with poor outcomes. The multivariate analysis showed that the outcome was
poor in 100% of cases in which consciousness disorders or the combination
of the remaining 3 factors were present, whereas in the absence of these factors,
a poor outcome was reported in only 11%. In 87% of the 45 patients with stroke
in group 2, the same clinical patterns were present on admission.
Conclusions The prognosis of BAS greater than 50% or BAO is diverse and certain
clinical characteristics seem to predict a lower risk of poor outcome. Their
presence may help to decide the most suitable therapy.
From the Departments of Neurology (Dr Devuyst, Bogousslavsky, Moncayo,
and de Freitas), and Radiology (Dr Meuli), Centre Hospitalier Universitaire
Vaudois, and the University Institute of Social and Preventive Medicine (Dr
van Melle), Lausanne, Switzerland.
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