CV

Vertebro-Basilar CVA

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Vertebro-Basilar CVA, Cerebrovascular Accident of Vertebral Artery, Cerebrovascular Accident of Basilar Artery, Vertebrobasilar Insufficiency, Wallenberg Syndrome, Locked-In Syndrome

  • Epidemiology
  1. Accounts for 1% of Ischemic Strokes
  • 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
  • Symptoms
  1. Often presents with Vertigo, Nystagmus, and Vomiting
  • 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
  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
  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
  • References
  1. (2019) Neuro-Psych, CCME National Board Review Course, accessed 6/7/2019