II. Epidemiology

  1. Accounts for 1% of Ischemic Strokes

III. Pathophysiology

  1. Findings are similar to Posterior Circulation findings to either PCA CVA or PICA CVA
    1. Affects Brainstem, Cerebellum, visual cortex
  2. Contralateral motor and sensory deficits
  3. Ipsilateral Cranial Nerve deficit
    1. Facial weakness or sensory deficit on the same side of the CVA)
  4. Crossed findings
    1. Crossed findings may also occur with Posterior Inferior Cerebellar Artery CVA
    2. Crossed findings include Wallenberg Syndrome affecting the lateral Medulla

IV. Symptoms

  1. Often presents with Vertigo, Nystagmus, and Vomiting

V. Findings: Signs and Symptoms

  1. Dysarthria
  2. Dysphagia
  3. Nausea
  4. Drop attacks or Syncope
  5. Cognitive Changes or mental status changes
    1. Memory loss
    2. Disorientation
    3. Coma
  6. Vestibular changes
    1. Vertigo
    2. Ataxic gait
  7. Visual changes
    1. Diplopia (Double Vision)
    2. Homonymous hemianopia
    3. Nystagmus
    4. Conjugate Gaze paralysis
    5. Ophthalmoplegia
  8. Hearing Changes
    1. Tinnitus
    2. Hearing Loss
  9. Akinetic mutism
    1. Locked-in-syndrome (Basilar ArteryOcclusion at pons)
  10. Motor or sensory deficits
    1. Quadriplegia
    2. Numbness of Tongue
    3. Facial weakness
    4. Alternating motor paresis

VI. Associated Conditions: Wallenberg's Syndrome (Vertebral ArteryOcclusion)

  1. Results from Vertebral Artery thrombosis
  2. Presents with Ataxia, Vertigo, Nystagmus and Vomiting
  3. Decreased pain and Temperature sensation
    1. Ipsilateral face
    2. Contralateral body
  4. Ipsilateral Horner's Syndrome
    1. Ptosis
    2. Miosis
    3. Anhidrosis

VII. Associated Conditions: Locked-In Syndrome (Basilar ArteryOcclusion at pons)

  1. Causes
    1. Basilar ArteryOcclusion at pons
    2. Pontine Hemorrhage
    3. Central Pontine Myelinolysis
  2. Complete motor paralysis with two exceptions
    1. Diaphragmatic breathing unaffected
    2. Vertical eye movements unaffected
  3. Neurologic function otherwise intact
    1. Awake, alert and lucid
    2. Cognitive function remains intact
    3. Intact sensation

VIII. References

  1. (2019) Neuro-Psych, CCME National Board Review Course, accessed 6/7/2019

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Locked-In Syndrome (C0023944)

Concepts Disease or Syndrome (T047)
MSH D011782
ICD9 344.81
ICD10 G83.5
SnomedCT 38023001
English Locked In Syndrome, Locked-In Syndrome, Syndrome, Locked-In, LOCKED-IN SYNDROME, Locked-in state, locked-in syndrome, locked-in syndrome (diagnosis), Locked-in syndrome, Locked-In Syndromes, Syndromes, Locked-In, locked in syndrome, locked syndrome, lock in syndrome, locking syndrome, pseudocoma, Locked in syndrome, Locked in syndrome (disorder)
Italian Sindrome da de-efferentazione motoria, Stato di de-efferentazione motoria, Sindrome locked-in, Sindrome del chiavistello
Dutch locked-in toestand, locked-in syndroom, Locked-in sundroom
German festsitzender Zustand, Locked-in-Syndrom, Locked-in Syndrom
Portuguese Estado locked-in, Síndrome do Cativeiro, SINDROME LOCKED-IN, Síndrome locked-in
Spanish Locked-in syndrome, Síndrome Encerrado, síndrome de encierro (trastorno), síndrome de desconexión pontina, locked-in, síndrome de desconexión pontina (trastorno), síndrome de encierro, seudocoma, Síndrome del cautiverio
Japanese 閉じ込め症候群, トジコメショウコウグン
French LIS (Locked-In Syndrome), SYNDROME LOCKED-IN, Syndrome de désefférentation, Locked-in syndrome, Syndrome d'enfermement, Syndrome de verrouillage
Czech Syndrom locked-in, Locked-in stav, locked-in syndrom, syndrom uzamčení
Hungarian Bezártság-szindróma (locked-in)
Norwegian Locked in-syndrom

Ontology: Vertebrobasilar Insufficiency (C0042568)

Definition (MSHCZE) Zkr. VBI – stav vznikající v důsledku porušeného oběhu krve v zadní části mozku. Ta je zásobena dvěma vertebrálními tepnami (a. vertebralis) procházejícími otvory v postranních výběžcích krčních obratlů a na spodině mozkové se spojujícími v jednu bazilární tepnu (a. basilaris). Vertebrální tepny mohou být zúženy vrozeně, vlivem anatomických podmínek (průchod zúženými místy) či aterosklerózy. Projevuje se např. závratěmi. Těžší porucha průtoku může způsobit i závažnější cévní mozkovou příhodu. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Localized or diffuse reduction in blood flow through the vertebrobasilar arterial system, which supplies the BRAIN STEM; CEREBELLUM; OCCIPITAL LOBE; medial TEMPORAL LOBE; and THALAMUS. Characteristic clinical features include SYNCOPE; lightheadedness; visual disturbances; and VERTIGO. BRAIN STEM INFARCTIONS or other BRAIN INFARCTION may be associated.
Concepts Disease or Syndrome (T047)
MSH D014715
ICD9 435.3
ICD10 G45.0
SnomedCT 155404005, 195196001, 266314007, 394517009, 64009001, 195199008
English Insufficiencies, Vertebrobasilar, Insufficiency, Vertebrobasilar, Vertebrobasilar Insufficiencies, Vertebrobasilar Insufficiency, VERTEBRAL BASILAR ARTERY INSUFFICIENCY, Vertebro-basilar artery syndrome, vertebrobasilar artery insufficiency (diagnosis), vertebrobasilar artery insufficiency, vertebrobasilar arterial insufficiency, Vertebrobasilar artery syndrom, Insufficiencies, Vertebro-Basilar, Insufficiency, Vertebro-Basilar, Vertebro Basilar Insufficiency, Vertebro-Basilar Insufficiencies, Vertebro-Basilar Insufficiency, Ischemia, Vertebro-Basilar, Vertebro Basilar Ischemia, Vertebro-Basilar Ischemia, Ischemias, Vertebro-Basilar, Vertebro-Basilar Ischemias, Ischemia, Vertebrobasilar, Vertebrobasilar Ischemia, Ischemias, Vertebrobasilar, Vertebrobasilar Ischemias, Vertbrobaslr artery synd, Vertebrobasilar Insufficiency [Disease/Finding], vertebro-basilar artery syndrome, vertebro-basilar insufficiency, vertebral basilar insufficiency, vertebrobasilar insufficiency, vertebro basilar insufficiency, basilar vertebral insufficiency, vertebrobasilar artery syndrome, vertebrobasilar ischemia, Vertebro-basilar insufficiency, Vertebro basilar insufficiency, Vertebrobasilar insufficiency (disorder), Vertebrobasilar insufficiency, Vertebrobasilar artery syndrome, Vertebrobasilar arterial insufficiency, Vertebrobasilar artery syndrome (disorder), a.vertebro-basilaris; syndrome, syndrome; vertebro-basilar artery, Insufficiency;vertebrobasilar
Dutch vertebrobasilair arterieel syndroom, a.vertebro-basilaris; syndroom, syndroom; arteria vertebro-basilaris, Vertebrobasilarissyndroom, vertebrobasilaire insufficiëntie, Insufficiëntie, vertebrobasilaire, Vertebrobasilaire insufficiëntie
French Syndrome vertébro-basilaire, Insuffisance vertébrobasilaire, Insuffisance vertébro-basilaire, Ischémie vertébro-basilaire, Ischémie vertébrobasilaire
Italian Sindrome dell'arteria vertebrobasilare, Ischemia vertebro-basilare, Ischemia vertebrobasilare, Insufficienza vertebrobasilare
Portuguese Síndrome de artéria vertebrobasilar, Insuficiência vertebrobasilar, Insuficiência Vertebrobasilar
Spanish Síndrome de la arteria vertebrobasilar, insuficiencia arterial vertebrobasilar, insuficiencia vertebrobasilar (trastorno), insuficiencia vertebrobasilar, síndrome de arteria vertebrobasilar (trastorno), síndrome de arteria vertebrobasilar, Insuficiencia vertebrobasilar, Insuficiencia Vertebrobasilar
Japanese 椎骨脳底動脈症候群, ツイコツノウテイドウミャクショウコウグン, ツイコツノウテイドウミャクフゼン, 椎骨脳底動脈循環不全症, 椎骨脳底動脈不全症候群, 脳底動脈不全, 椎骨動脈不全症, 脳底動脈不全症, 椎骨脳底動脈血行不全, 椎骨脳底動脈不全, 椎骨動脈不全症候群, 椎骨脳底動脈循環障害, 椎骨-脳底動脈循環不全, 椎骨脳底動脈循環不全
Czech vertebrobazilární insuficience, Syndrom vertebrobazilární tepny, Vertebrobazilární insuficience, insuficience ve vertebrobazilárním povodí, insuficience ve VB povodí
Finnish Nikamavaltimo-kallonpohjavaltimo-oireyhtymä
Russian BAZILIARNOI ARTERII NEDOSTATOCHNOST', POZVONOCHNOI ARTERII NEDOSTATOCHNOST', VERTEBRAL'NO-BAZILIARNAIA NEDOSTATOCHNOST', VERTEBROBAZILIARNAIA NEDOSTATOCHNOST', ВЕРТЕБРОБАЗИЛЯРНАЯ НЕДОСТАТОЧНОСТЬ, БАЗИЛЯРНОЙ АРТЕРИИ НЕДОСТАТОЧНОСТЬ, ВЕРТЕБРАЛЬНО-БАЗИЛЯРНАЯ НЕДОСТАТОЧНОСТЬ, ПОЗВОНОЧНОЙ АРТЕРИИ НЕДОСТАТОЧНОСТЬ
German Arteria-vertebralis-Syndrom mit Basilaris-Symptomatik, vertebrobasilaere Insuffizienz, Vertebrobasiläre Insuffizienz
Swedish Arteria vertebrobasilaris-insufficiens
Korean 척추-뇌저 동맥 증후군
Croatian VERTEBROBAZILARNA INSUFICIJENCIJA
Polish Niewydolność kręgowo-podstawna, Niewydolność tętnic kręgowo-podstawnych, Zespół kręgowo-podstawny
Hungarian Arteria vertebro-basilaris-syndroma, Vertebrobasilaris elégtelenség
Norwegian Dårlig blodstrøm i vertebralis- og basilarisarteriene, Vertebrobasilarisinsuffisiens

Ontology: Lateral Medullary Syndrome (C0043019)

Definition (NCI) A syndrome caused by an infarct in the vertebral or posterior inferior cerebellar artery. It is characterized by sensory defects affecting the same side of the face as the infarct and the opposite side of the trunk as the infarct. Patients experience difficulty swallowing and/or speaking.
Definition (MSH) INFARCTION of the dorsolateral aspect of MEDULLA OBLONGATA in the BRAIN STEM. It is caused by occlusion of the VERTEBRAL ARTERY and/or the posterior inferior cerebellar artery. Clinical manifestations vary with the size of infarction, but may include loss of pain and temperature sensation in the ipsilateral face and contralateral body below the chin; ipsilateral HORNER SYNDROME; ipsilateral ATAXIA; DYSARTHRIA; VERTIGO; nausea, hiccup; dysphagia; and VOCAL CORD PARALYSIS. (From Adams et al., Principles of Neurology, 6th ed, p801)
Concepts Disease or Syndrome (T047)
MSH D014854
ICD10 G46.3
SnomedCT 195193009, 78569004
English Lateral Bulbar Syndrome, Posterior Inferior Cerebellar Artery Syndrome, Wallenberg Syndrome, Wallenberg's Syndrome, Wallenbergs Syndrome, Wallenberg syndrome, LMS - Lateral medullary syndr, stroke of posterior inferior cerebellar artery (diagnosis), stroke of posterior inferior cerebellar artery, Dorsolateral Medullary Syndrome, Medullary Syndrome, Dorsolateral, Lateral Medullary Syndrome, Syndrome, Vieseaux-Wallenberg, Vieseaux Wallenberg Syndrome, Vieseaux-Wallenberg Syndrome, Syndrome, Wallenberg, Lateral Medullary Syndrome [Disease/Finding], syndrome wallenberg, lateral medullary syndrome, wallenberg's syndrome, wallenberg syndrome, wallenbergs syndrome, Lateral Medullary Syndromes, Syndromes, Lateral Medullary, Inferior cerebellar artery syndrome, Lateral medullary syndrome, Posterior inferior cerebellar artery syndrome, Wallenberg's syndrome, LMS - Lateral medullary syndrome, Posterior inferior cerebellar artery syndrome (disorder)
Japanese 外側髄症候群, ガイソクズイショウコウグン, ワレンベルグショウコウグン, Wallenberg症候群, 延髄外側症候群, ワレンベルグ症候群, 外側延髄症候群, 後下小脳動脈症候群, ヴァレンベルグ症候群
Swedish Lateralt medullärt syndrom
Czech Wallenbergův syndrom, syndrom PICA, laterální míšní syndrom, Syndrom dorzolaterální oblongáty-Wallenbergův
Finnish Wallenbergin oireyhtymä
French Syndrome latéral du bulbe, Syndrome médullaire latéral, Syndrome latéro-bulbaire, Syndrome de Wallenberg, lnfarctus latérobulbaire
Russian ZADNEI NIZHNEI ARTERII MOZZHECHKA SINDROM, MOZZHECHKA ZADNEI NIZHNEI ARTERII SINDROM, LATERAL'NYI MEDULLIARNYI SINDROM, ЗАДНЕЙ НИЖНЕЙ АРТЕРИИ МОЗЖЕЧКА СИНДРОМ, ЛАТЕРАЛЬНЫЙ МЕДУЛЛЯРНЫЙ СИНДРОМ, МОЗЖЕЧКА ЗАДНЕЙ НИЖНЕЙ АРТЕРИИ СИНДРОМ
Italian Sindrome bulbare laterale, Sindrome midollare laterale, Sindrome di Vieseaux-Wallenberg, Sindrome dell'arteria cerebellare inferiore posteriore, Sindrome dorsolaterale midollare, Sindrome di Wallenberg
Polish Zespół Wallenberga, Zespół tętnicy móżdżkowej tylnej dolnej, Zespół rdzeniowy boczny
Hungarian Wallenberg-syndroma, Lateralis nyúltvelői syndroma (Wallenberg)
Norwegian PICA-syndromet, Wallenbergs syndrom, Arteria cerebellaris posterior-inferior-syndrom, Lateralt medullært syndrom
Spanish síndrome de Wallenberg (trastorno), síndrome de Wallenberg, síndrome de arteria cerebelosa posterior inferior, síndrome de la arteria cerebelosa inferior, síndrome de la arteria cerebelosa posteroinferior, síndrome medular lateral, Síndrome de Wallemberg, Síndrome medular lateral, Síndrome Bulbar Lateral, Síndrome de la Arteria Cerebelar Posteroinferior, Síndrome de Wallenberg, Síndrome Medular Lateral
Portuguese Síndrome medular lateral, Síndrome Bulbar Lateral, Síndrome da Artéria Cerebelar Posteroinferior, Síndrome de Wallenberg, Síndrome Medular Lateral
Dutch lateraal medullair syndroom, syndroom van Wallenberg, Arteria-cerebelli-posterior-inferiorsyndroom, Lateraal bulbair syndroom, Laterale medulla-oblongatasyndroom, Syndroom van Wallenberg, Syndroom, laterale medulla-oblongata-
German Wallenberg Sandrom, Wallenberg Syndrom, Wallenberg-Syndrom, Oblongata-Syndrom, laterales, Wallenberg-Foix-Syndrom, Syndrom der Arteria cerebelli inferior posterior, Laterales medulläres Syndrom

Ontology: Occlusion and stenosis of vertebral artery (C0155724)

Concepts Pathologic Function (T046)
ICD9 433.2
ICD10 I65.0
English Occlusion and stenosis of vertebral artery
Dutch arteria vertebralis occlusie en stenose, Occlusie en stenose van arteria vertebralis
German Verschluss und Stenose der Arteria vertebralis, Verschluss und Stenose der A. vertebralis
Italian Occlusione e stenosi della arteria vertebrale
Portuguese Oclusão e estenose de artéria vertebral
Spanish Oclusión y estenosis de la arteria vertebral
French Occlusion et sténose de l'artère vertébrale
Czech Okluze a stenóza vertebrální tepny
Korean 척추뼈동맥의 폐색 및 협착
Hungarian Arteria vertebralis elzáródás és szűkület

Ontology: Basilar artery occlusion (C0265098)

Concepts Anatomical Abnormality (T190)
ICD9 433.0
ICD10 I65.1
SnomedCT 78658006, 155396001, 195180004
English Occlusion and stenosis of basilar artery, basilar artery occlusion, basilar artery occlusion (diagnosis), Basilar artery occlusion, occlusion basilar artery, Basilar artery obstruction (disorder), Occlusion of basilar artery, Basilar artery occlusion (disorder), a.basilaris; occlusion, obstruction; basilar artery, occlusion; basilar artery, Basilar artery obstruction
Italian Occlusione dell'arteria basilare, Occlusione e stenosi della arteria basilare
Dutch arteria basilaris occlusie en stenose, a.basilaris; afsluiting, afsluiting; arteria basilaris, obstructie; arteria basilaris, Occlusie en stenose van arteria basilaris, arteria basilaris occlusie
French Occlusion et sténose de l'artère basilaire, Oblitération du tronc basilaire
German Verschluss und Stenose der Arteria basilaris, Verschluss und Stenose der A. basilaris, Verschluss der Arteria basilaris
Portuguese Oclusão e estenose da artéria basilar, Oclusão da artéria basilar
Spanish Oclusión y estenosis de la arteria basilar, obstrucción de la arteria basilar, obstrucción de la arteria basilar (trastorno), oclusión de la arteria basilar, oclusión de arteria basilar (trastorno), oclusión de arteria basilar, Oclusión de arteria basilar, obstrucción de arteria basilar
Japanese 脳底動脈閉塞, ノウテイドウミャクヘイソク
Czech Okluze a stenóza arteria basilaris, Okluze arteria basilaris
Korean 뇌저동맥의 폐색 및 협착
Hungarian Arteria basilaris elzáródás, Arteria basilaris elzáródás és szűkület