Basilar artery thrombosis occurs due to calcified arteries. Immediate medical indication is extremely important because basilar artery thrombosis is life-threatening. Basilar artery thrombosis is a special type of insult (stroke).
What is basilar artery thrombosis?
Infographic on the anatomy and causes of cardiovascular disease, such as stroke. Click image to enlarge. This special type of stroke primarily affects the brain. The so-called brainstem infarct often occurs directly in the center of the brainstem, which regulates the person’s level of consciousness as well as his or her breathing control. Because of these factors, basilar artery thrombosis is life-threatening and requires immediate medical attention. As in the case of a stroke, the earlier the treatment, the better the chances of a complete recovery. Thus, at the first sign of basilar artery thrombosis, the patient should not hesitate to seek immediate medical attention.
Causes
One of the main causes of why basilar artery thrombosis occurs in the first place is arteriosclerosis. Arteriosclerosis is a classic calcification of the arteries. If the patient suffers basilar artery thrombosis, one of the two (or both) vertebral arteries of the brain stem is affected by the calcification. This calcification causes a restriction of blood supply, which subsequently leads to a brainstem infarction. The medical profession refers to basilar artery thrombosis when one of the two (or both) vertebral arteries is occluded and a blood clot forms, causing brainstem infarction. Locked-in syndrome is considered the most severe form of infarction. Classic symptoms include paralysis over the entire body and sensory disturbances. The patient also complains of sensory disturbances and difficulty swallowing. Due to the fact that the infarct occurs in the center of respiratory control, the patient suffers from breathing difficulties and complains of increasing shortness of breath. Furthermore, disorders of consciousness occur as well as speech disorders.
Symptoms, complaints, and signs
Basilar artery thrombosis can lead to very serious and dangerous symptoms. As a rule, the affected person suffers from disorders of consciousness in this case, and in the worst case, coma can occur. In the event of a loss of consciousness, the affected person may additionally injure himself in the event of a fall. Dysphagia, visual disturbances or double vision also frequently occur as a result of basilar artery thrombosis and make the patient’s life extremely difficult. Furthermore, this disease can also lead to speech disorders or paralysis of the extremities. Many patients also suffer from vomiting or nausea, resulting in severe weight loss. In the further course of the disease, severe respiratory problems occur, from which the affected person can die in the worst case. Most patients also suffer from dizziness and eye tremor. As a result, they are often dependent on the help of other people in their daily lives and can no longer perform many everyday tasks on their own. Psychological complaints can also occur as a result of basilar artery thrombosis, and parents or relatives can also be affected by these complaints. If left untreated, basilar artery thrombosis leads to the death of the affected person. The respiratory problems may also cause permanent damage to the internal organs or brain.
Diagnosis and course
If basilar artery thrombosis is suspected, the physician orders a computed tomography – CT – scan. This diagnostic method is intended to provide an indication of whether a brainstem infarction is present. Computed tomography of the skull is also often referred to as “cranial computed tomography“. It is also possible to use magnetic resonance imaging; however, this is rarely used – in the context of diagnosing basilar artery thrombosis. Another option is the MR angiography procedure. With this procedure, it is possible for the physician to localize the site of the infarct using diagnostic imaging. The course of basilar artery thrombosis depends primarily on how severely the patient is affected by the infarction. Mild, but also very severe cerebral infarctions may occur. Likewise, rehabilitation measures are necessary so that the patient can master his old abilities again or, if necessary, relearn them. In the case of a mild infarction – such as Wallenberg syndrome – independent living is possible again after rehabilitation.If the patient suffers a severe brainstem infarction, this can sometimes result in longer-term restrictions and permanent damage. Movement restrictions often remain as a late consequence.
Complications
Usually, basilar artery thrombosis is an insult, which can be life-threatening to the human body. Without treatment, the patient may die in the worst case. The result is severe disturbances of consciousness, loss of consciousness or even coma. Patients suffer from severe visual disturbances and nausea. Paralysis occurs in certain parts of the body, resulting in severe restrictions of movement. The paralyses can also affect breathing, leading to breathing disorders and panic attacks. Basilar thrombosis is often accompanied by dizziness and vomiting. The patient’s daily life is considerably restricted and the quality of life is greatly reduced. It is no longer possible for the patient to perform physical activities. Treatment of basilar artery thrombosis must be rapid and usually takes the form of surgery. After the operation, a long rehabilitation phase is necessary for the affected person, as paralysis or damage to individual body parts often occurs. Physiotherapy measures can alleviate these complaints or symptoms. However, it cannot be predicted whether all symptoms will completely disappear again, as some damage to the body is irreversible.
When should you see a doctor?
At the first signs of basilar artery thrombosis, such as dizziness and vomiting, and the simultaneous appearance of neurological problems such as clouding of consciousness, impaired vision and speech, and paralysis with respiratory problems, the question of whether to see a doctor does not arise at the very beginning. It is absolutely necessary to consult a doctor! The situation is immediately life-threatening and requires immediate treatment in a special clinic. If the necessary systemic dissolution or surgical removal of the thrombus blocking the basilar artery and causing brainstem infarction is not performed immediately, there is an acute life-threatening situation with a very poor prognosis. Clinics that can locate thrombi in the brain, for example, and use systemically effective agents or locally effective procedures to dissolve or surgically remove the thrombus are appropriate for acute treatment. If the dissolution or removal of the thrombus is successful, rehabilitative measures are used to try to get as close as possible to everyday life again. Some of the rehabilitation measures are similar to those used after strokes. To prevent recurrence of thrombosis, regular examinations or checks of important arteries for arteriosclerosis should be performed in a clinic or doctor’s office that has suitable sonography equipment. To keep the risk of atherosclerosis low, it is recommended that the diet be as natural as possible and suitable for keeping the ratio of the LDL fraction to the HDL fraction of total cholesterol less than 3.5.
Treatment and therapy
Before brainstem infarction is treated, it is important that treatment begin as soon as possible. Depending on the type and severity as well as the form of the infarction, the medical professional will decide on the treatment method. Another factor in the decision is the physical condition of the affected person. In the case of an occlusion of the vertebral arteries and a subsequent brain stem infarction, local thrombolysis is usually used. The physician dissolves the blood clots in the arteries by means of lysis. Drugs are used here to dissolve the clot. Another, alternative option is surgery. Here, the physician removes the blood clots on a surgical basis. If the patient complains of difficulty swallowing or shortness of breath, it is often necessary for the physician to insert a stomach tube. Long-term ventilation may also be used. Many experts believe that patients who have suffered a brainstem infarction should be treated in a specialist medical center. Especially rehabilitation and therapy should be carried out in such a specialized center; here there is a higher success rate for faster or complete recovery of the patient. After the treatment of brainstem infarction, it is important that a consistent therapy takes place. This takes the form of physiotherapeutic measures and exercises.In this way, any movement restrictions should be remedied so that the patient does not suffer any permanent damage. However, a corresponding therapy often takes months.
Outlook and prognosis
The prognosis depends on the type and severity of basilar artery thrombosis. Rarely, there is complete recovery and freedom from symptoms. Most patients suffer lifelong sequelae and require long-term therapy. Basilar artery thrombosis requires immediate intensive medical care. Without treatment, the patient will die within the next few hours or days. The later a diagnosis is made and treatment is started, the poorer the chances of recovery. Additionally, the age and health of the patient are elemental to the healing process. People in middle adulthood, with no other illnesses and a stable immune system have the best chance of recovery if they are treated as soon as possible. In most cases, despite all efforts and prompt medical care, various functional disorders persist for a long time after basilar artery thrombosis. Paralysis, speech disorders and severe impairments in coping with everyday life occur. Often the patient is dependent on daily assistance and can no longer perform his usual work. The patient’s therapy after surviving basilar artery thrombosis is individual and depends on the sequelae. In most cases, the patient needs several years before he can perform many familiar activities again. Some of them he will never perform again.
Prevention
The patient can only prevent basilar artery thrombosis to a limited extent. The bottom line is that arteriosclerosis, the calcification of the two arteries, must be prevented or fought. This means that the patient must go for regular check-ups to clarify the situation. Especially overweight people, who suffer from high blood pressure and have an unhealthy lifestyle, are usually affected by arteriosclerosis. Therefore, high-risk patients in particular should go for regular medical checkups to avert basilar artery thrombosis.
What you can do yourself
Basilar artery thrombosis can be considered a special type of stroke. When one or both basilar arteries, which supply oxygen and nutrients to the brainstem, including the respiratory center, are blocked by a blood clot, a brainstem infarction is caused with sometimes serious consequences. In acute cases, there are no known self-help measures that could prevent the effects from worsening, because in acute cases, the focus is exclusively on diagnostic measures to precisely localize the thrombus and dissolve it by thrombolysis or surgical removal so that the corresponding brain regions can be supplied with oxygen again. It is obvious that basilar artery thrombosis must be treated as quickly as possible, because the effects – left untreated – quickly increase and then usually prove irreversible. The prognosis if not treated is very unfavorable and does not exclude fatal consequences. Depending on the severity of the damage left by the infarction, adjustments in everyday life and also self-help measures are required. Self-help measures mainly consist of rehabilitation support in consultation with the physiotherapist and the attending physician. The exercises to be applied are individualized and partly comparable to exercises that are available after a classic stroke. They serve to get back as close as possible to the previous everyday life, if that can be a realistic goal at all.
