Vertebral and Basilar Artery Thrombosis
Vertebral and Basilar Artery Thrombosis Vertebral and basilar artery thrombosis are serious cerebrovascular conditions that can lead to devastating neurological outcomes. These conditions involve the formation of blood clots within the vertebral or basilar arteries, which are key components of the posterior circulation supplying blood to critical areas of the brain, including the brainstem, cerebellum, and occipital lobes. Due to their location and function, thrombosis in these arteries can cause a spectrum of neurological deficits, often presenting as sudden-onset, severe symptoms that require immediate medical attention.
Vertebral and Basilar Artery Thrombosis The vertebral arteries originate from the subclavian arteries and ascend through the cervical vertebrae, entering the skull through the foramen magnum. They supply blood to the posterior part of the brain, including the cerebellum and parts of the brainstem. Thrombosis in these arteries can result from atherosclerosis, trauma, or embolic events, leading to ischemia or infarction in the regions they supply. Symptoms might include dizziness, vertigo, imbalance, visual disturbances, or limb weakness. Because these symptoms can overlap with other neurological conditions, prompt imaging studies such as magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are essential for accurate diagnosis.
Vertebral and Basilar Artery Thrombosis The basilar artery forms at the junction of the two vertebral arteries and runs along the brainstem, supplying vital structures such as the pons, cerebellum, and occipital lobes. Thrombosis here is particularly dangerous, as it can cause extensive brainstem infarction, leading to severe neurological deficits or death. Patients with basilar artery thrombosis often present with sudden onset of quadriplegia, coma, cranial nerve deficits, or locked-in syndrome, which is characterized by paralysis of nearly all voluntary muscles except for eye movements.
The pathophysiology of thrombosis in these arteries involves a combination of endothelial injury, blood flow stasis, and hypercoagulability—factors often summarized as Virchow’s triad. Atherosclerosis is the most common underlying cause, especially in older adults with risk factors such as hypertension, diabetes, smoking, and hyperlipidemia. Additionally, embolic phenomena originating from the heart or extracranial arteries can also lead to thrombus formation. Once formed, the thrombus can occlude the vessel completely or partially, impairing blood flow and leading to ischemic injury. Vertebral and Basilar Artery Thrombosis
Vertebral and Basilar Artery Thrombosis Diagnosis relies heavily on neuroimaging techniques. MRI combined with MRA provides detailed visualization of the arteries and can identify thrombi and areas of infarction. Computed tomography angiography (CTA) is also useful, especially in emergency settings. Laboratory tests may assist in identifying underlying causes, such as hypercoagulable states, infections, or cardiac sources of emboli.
Treatment strategies aim to restore blood flow as quickly as possible to minimize brain damage. Thrombolytic therapy with tissue plasminogen activator (tPA) can be considered within a narrow time window after symptom onset, provided there are no contraindications. Anticoagulation with heparin or other agents helps prevent further clot formation. In some cases, mechanical thrombectomy—where a device is used to physically remove the clot—offers an effective option, especially in large vessel occlusions. Supportive care, including managing intracranial pressure and stabilizing vital functions, is crucial.
Preventing future events involves addressing risk factors through lifestyle modifications and medical management. Controlling blood pressure, cholesterol, and blood sugar, along with smoking cessation and antiplatelet therapy, can significantly reduce the risk of recurrent thrombosis. Regular medical follow-up and imaging are necessary for high-risk patients.
Vertebral and Basilar Artery Thrombosis In conclusion, vertebral and basilar artery thrombosis are serious cerebrovascular emergencies requiring rapid diagnosis and intervention. Advances in neuroimaging and endovascular treatments have improved outcomes, but early recognition remains critical to prevent permanent neurological deficits and improve survival rates.
