Top of the basilar syndrome
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Top of the basilar syndrome, (also known as rostral brainstem infarction) occurs when there is thromboembolic occlusion of the top of the basilar artery. This results in bilateral thalamic ischaemia due to occlusion of perforator vessels.
Clinical presentation
Clinically, top of the basilar syndrome is characterised by :
- visual and oculomotor deficits
- behavioural abnormalities
- somnolence, hallucinations and dreamlike behaviour
- motor dysfunction is often absent
Radiographic features
On CT the finding that should not be missed is that of a hyperdense basilar artery and imaging features are discussed further in the more general article on acute basilar artery occlusion.
Angiography (CT, MR, catheter) can be used to confirm the finding, demonstrating a filling defect.
Differential diagnosis
The pattern of established infarction can be mimicked by:
- artery of Percheron infarct
- bilateral internal veins thrombosis (dural venous sinus thrombosis)
- other causes of thalamic restricted diffusion
-<li>bilateral internal veins thrombosis (<a href="/articles/dural_venous_sinus_thrombosis">dural venous sinus thrombosis</a>)</li>- +<li>bilateral internal veins thrombosis (<a href="/articles/dural-venous-sinus-thrombosis">dural venous sinus thrombosis</a>)</li>
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