Brainstem ischemia, steno-occlusive pathology of the vertebral arteries, and alterations in the circadian blood pressure pattern: a case report

J Stroke Cerebrovasc Dis. 2009 Jul-Aug;18(4):309-12. doi: 10.1016/j.jstrokecerebrovasdis.2008.11.003.


We report the case of a patient with vertebrobasilar steno-occlusive pathology associated with ischemic brainstem symptomatic lesions related to abnormal decrease in blood pressure (BP). A 63-year-old man presented vertigo and persistent gait impairment as a result of a posterior cerebellar infarction and, during hospitalization, experienced a new episode of cerebral ischemia in the territory of the anterior cerebellar artery. Cerebral angiography showed occlusion of the left vertebral artery and two severe stenoses of the right vertebral artery, and 24-hour dynamic BP monitoring evidenced severe postprandial hypotension. Medical treatment was not effective so he underwent an endovascular procedure. This report documents the importance of BP monitoring for a better understanding of the pathophysiology of posterior ischemic strokes and, above all, for a more reliable prognosis and therapy.

Publication types

  • Case Reports

MeSH terms

  • Angioplasty
  • Brain Stem Infarctions / etiology*
  • Brain Stem Infarctions / pathology
  • Brain Stem Infarctions / physiopathology
  • Cerebellar Diseases / diagnosis
  • Cerebellar Diseases / etiology
  • Cerebellar Diseases / physiopathology
  • Cerebral Angiography
  • Chronobiology Disorders / complications*
  • Chronobiology Disorders / physiopathology
  • Humans
  • Hypotension / complications*
  • Hypotension / etiology
  • Hypotension / physiopathology
  • Ischemic Attack, Transient / diagnosis
  • Ischemic Attack, Transient / etiology*
  • Ischemic Attack, Transient / physiopathology
  • Male
  • Middle Aged
  • Monitoring, Physiologic
  • Postprandial Period / physiology
  • Stents
  • Treatment Outcome
  • Vertebral Artery / diagnostic imaging
  • Vertebral Artery / pathology
  • Vertebral Artery / physiopathology
  • Vertebrobasilar Insufficiency / complications*
  • Vertebrobasilar Insufficiency / diagnostic imaging
  • Vertebrobasilar Insufficiency / etiology*
  • Vertebrobasilar Insufficiency / pathology
  • Vertebrobasilar Insufficiency / physiopathology