Subarachnoid Hemorrhage as a Presentation of Basilar Artery Dissection

Zubkov, Alexander Y.; Sanghvi, Amit N.; Cloft, Harry J.; Wijdicks, Eelco F. M.; Rabinstein, Alejandro A.

doi:10.1007/s12028-007-0071-3

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…The reference to existing case reports in the literature that illustrate ongoing ischemichemorrhagic processes is important, as it underscores the clinical relevance of our research [26][27][28][29][30]. These reports support the notion that brain stem infarcts are often the result of subintimal pathologies developing in the basilar artery and that these events are part of an ongoing clinical process that involves both ischemia and hemorrhage [6,31,32].…”

Section: Accepted Manuscriptsupporting

confidence: 70%

Intimal Hemorrhage of Basilar Artery Induced by Severe Vasospasm Following Subarachnoid Hemorrhage: The Experimental Analysis

Gökyar,

Şahin,

Karadağ

et al. 2024

J Neurol Surg A Cent Eur Neurosurg

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Background: Cerebral vasospasm, a serious complication of subarachnoid hemorrhage (SAH), has been extensively studied for its neurochemical and pathophysiological mechanisms. However, the contribution of inner elastic membrane dissection and subintimal hemorrhage to basilar artery occlusion remains underexplored. This study investigates inner elastic membrane-related changes in the basilar artery after SAH. Methods: Twenty-four hybrid rabbits were divided into control, sham, and SAH groups, with SAH induced by autologous blood injection. After two weeks, basilar artery changes, vasospasm indexes (VSI), and dissections were evaluated. Results: The SAH group showed significantly higher VSI, with vascular wall thickening, luminal narrowing, convoluted smooth muscle cells, intimal elastic membrane disruption, endothelial cell desquamation and apoptosis. Some SAH animals exhibited subintimal hemorrhage, inner elastic membrane dissection, and ruptures. Basilar arteries with subintimal hemorrhage had notably higher VSI. Conclusions: These findings highlight the role of subintimal hemorrhage and inner elastic membrane dissection in basilar artery occlusion post-SAH, offering valuable insights into vasospasm pathophysiology.

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Section: Accepted Manuscriptsupporting

confidence: 70%

Intimal Hemorrhage of Basilar Artery Induced by Severe Vasospasm Following Subarachnoid Hemorrhage: The Experimental Analysis

Gökyar,

Şahin,

Karadağ

et al. 2024

J Neurol Surg A Cent Eur Neurosurg

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“…However, this finding is seen in only about 13% of cases (11). These features along with a detectable intimal flap on FLAIR imaging of MRI is highly characteristics of a dissection (5,25). All these findings were present in our case.…”

Section: Outcomesupporting

confidence: 42%

“…However, growing dissections leads to two clinical scenarios based on two typical pathological features (2,25). In those cases where dissection occurs between intima elastic lamina and media, a growing intramural thrombosis might lead to stenosis or obliteration of BA leading to brain stem infarct, In the second case scenario where dissection involves …”

Section: Outcomementioning

confidence: 99%

“…However, owing to limited data about its pathogenesis and natural course, the suitable therapeutic strategies for dissection of the BA remain controversial (2,7,14,20,21,25). Unlike dissection involving both VA and BA, isolated BA dissections are generally asymptomatic and rarely cause subarachnoid hemorrhage (2,3,5,7,25). As such, conservative management is recommended in most cases.…”

Section: Introductionmentioning

confidence: 99%

“…However, surgical interventions are essential for those patients with progressive deterioration secondary to rupture or bleeding (5,7,14,24). The current therapeutic options mainly include endovascular treatment, wrapping to reinforce the dissected wall, direct surgical ligation or clipping and arterial reconstruction (14,20,21,25). The safety and efficacy of these techniques are not well documented except for a few anecdotal descriptions.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular coil embolization of parent artery for giant intracranial basilar artery dissection: a case report

Xu²,

Wang³

et al. 2010

Turkish Neurosurgery

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Isolated dissection of the basilar artery (BA) is rare and still a big challenge regarding treatment. The suitable therapeutic strategies for dissection of the BA remain controversial. We report the case of a young patient with a giant unruptured dissection of the BA successfully treated by endovascular coil embolization. A 14-year-old male who underwent computed tomography (CT) scan following a minor head trauma was incidentally found to have a lesion located anterior to brain stem. Further imaging with magnetic resonance imaging (MRI), computed tomography angiography (CTA) and digital subtraction angiography (DSA) were consistent with a diagnosis of giant unruptured dissection of the BA. The patient was initially observed conservatively. The follow-up DSA obtained 3 months later revealed extension of the dissection inferiorly to involve the left VA. The dissection expanded at the conjunction of VAs in the shape of ball. Therefore, coil embolization to occlude BA at the bottom of aneurysm was performed as a further treatment. Follow-up DSA 6 months later demonstrated complete obliteration of the dissection and good compensative perfusion from extensively collateral circulation. For young patients with isolated dissection of the BA, coil embolization to occlude BA at the bottom of aneurysm might be tolerable and effective.KeywoRds: Basilar artery, Giant, Dissection, Endovascular embolization, Treatment ÖZBaziler arterin (BA) izole diseksiyonu nadirdir ve tedavisi halen zordur. BA diseksiyonu için uygun terapötik stratejiler tartışmalıdır. Dev bir rüptüre olmamış BA diseksiyonu bulunan ve endovasküler sarmal embolizasyonuyla başarıyla tedavi edilen genç bir hasta sunuyoruz. Küçük bir kafa travması sonrasında bilgisayarlı tomografi (BT) yapılan 14 yaşında bir erkek hastada beyin kökünün önünde bir lezyon saptandı. Manyetik rezonans görüntüleme (MRG), bilgisayarlı tomografi anjiyografi (BTA) ve dijital subtraksiyon anjiyografisi (DSA) ile yapılan ileri görüntüleme sonuçları rüptüre olmamış dev BA diseksiyonu tanısıyla uyumluydu. Hasta başlangıçta konservatif olarak izlendi. Üç ay sonra çekilen takip DSA, diseksiyonun inferiora uzanıp sol VA'yı da olaya kattığını gösterdi. Diseksiyon VA'ların birleşiminde bir top şeklinde genişlemişti. Bu nedenle ileri tedavi olarak anevrizma dibinde BA oklüzyonu için sarmal embolizasyonu yapıldı. Altı ay sonra yapılan kontrol DSA diseksiyonda tam obliterasyon ve yaygın kollateral dolaşımdan iyi kompanse edici perfüzyon gösterdi. İzole BA diseksiyonu olan hastalarda anevrizma dibinde BA oklüzyonu için sarmal embolizasyonu tolere edilebilir ve etkin olabilir. ANAHTAR sÖZCÜKLeR:Baziler arter, Dev, Diseksiyon, Endovasküler embolizasyon, Tedavi

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Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage

Cohen

Moscovici

Rajz

et al. 2016

Journal of Clinical Neuroscience

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Subarachnoid Hemorrhage as a Presentation of Basilar Artery Dissection

Abstract: Basilar artery dissection can present with subarachnoid hemorrhage. No guidelines are available for management of basilar artery dissections and treatment should be tailored to the individual patient.

Cited by 6 publications

References 16 publications

Intimal Hemorrhage of Basilar Artery Induced by Severe Vasospasm Following Subarachnoid Hemorrhage: The Experimental Analysis

Intimal Hemorrhage of Basilar Artery Induced by Severe Vasospasm Following Subarachnoid Hemorrhage: The Experimental Analysis

Endovascular coil embolization of parent artery for giant intracranial basilar artery dissection: a case report

Chronic basilar artery dissection with an associated symptomatic aneurysm presenting with massive subarachnoid hemorrhage

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