Magnetic resonance imaging in basilar artery occlusion

Arch Neurol. 2002 Mar;59(3):398-402. doi: 10.1001/archneur.59.3.398.


Context: Acute basilar artery occlusion has particularly high mortality and morbidity.

Objective: To determine the potential utility of advanced magnetic resonance imaging (MRI) methods, including diffusion-weighted imaging, for the early management of patients with basilar artery thrombosis.

Design: Case series.

Setting: Institute of Neuroradiology and Department of Neurology, Johann Wolfgang Goethe University, Frankfurt, Germany.

Patients: In 4 patients with occlusion of the basilar artery, MRI was performed, including T2-weighted and diffusion-weighted imaging (DWI) sequences and magnetic resonance angiography (MRA) in the short-term phase (<12 hours). Three patients underwent intra-arterial thrombolysis. Clinical outcome was obtained 10 days after symptom onset.

Results: The MRA was performed 3.5 to 11.5 hours after symptom onset and showed basilar artery occlusion in all cases. The DWI revealed different patterns of ischemic lesions. In 2 patients, no or only small lesions could be identified; the remaining showed multiple and large lesions within the posterior circulation territory. Initial clinical status was severely impaired in all cases (Rankin scale score, 4-5). Thrombolysis was initiated in 3 patients, leading to successful recanalization in 2. Clinical outcome was favorable in the 2 patients with small DWI lesions and successful reperfusion (Rankin scale score, 2), whereas it was worse in those with large DWI lesions and persisting occlusion (death, persisting coma).

Conclusions: In critically ill patients with acute basilar occlusion, the extent of DWI lesion involvement can be highly variable. Small DWI lesions seem to be associated with a favorable outcome if reperfusion is achieved with thrombolysis. This could potentially be the case independent of time from symptom onset.

Publication types

  • Case Reports
  • Evaluation Study

MeSH terms

  • Aged
  • Arterial Occlusive Diseases / diagnosis*
  • Arterial Occlusive Diseases / drug therapy
  • Basilar Artery / pathology*
  • Female
  • Humans
  • Magnetic Resonance Angiography*
  • Magnetic Resonance Imaging*
  • Male
  • Plasminogen Activators / therapeutic use
  • Thrombolytic Therapy
  • Treatment Outcome
  • Urokinase-Type Plasminogen Activator / therapeutic use


  • Plasminogen Activators
  • Urokinase-Type Plasminogen Activator