Top of the basilar syndrome
Last revised by Mostafa Elfeky on 13 Jul 2023
Citation, DOI, disclosures and article data
Citation:
Gaillard F, Elfeky M, Glick Y, et al. Top of the basilar syndrome. Reference article, Radiopaedia.org (Accessed on 11 Oct 2024) https://doi.org/10.53347/rID-6257
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rID:
6257
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Disclosures:
At the time the article was created Frank Gaillard had no recorded disclosures.
View Frank Gaillard's current disclosures
Last revised:
13 Jul 2023,
Mostafa Elfeky ◉
Disclosures:
At the time the article was last revised Mostafa Elfeky had no financial relationships to ineligible companies to disclose.
View Mostafa Elfeky's current disclosures
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- Top of the basilar artery syndrome
- Tip of the basilar syndrome
- Top of basilar syndrome
- Top of basilar artery syndrome
Top of the basilar syndrome, also known as rostral brainstem infarction, occurs when there is thromboembolic occlusion of the top of the basilar artery. This results in bilateral thalamic ischemia due to occlusion of perforator vessels.
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Clinical presentation
Clinically, top of the basilar syndrome is characterized by:
- visual and oculomotor deficits
- behavioral abnormalities
- somnolence, hallucinations and dreamlike behavior
- motor dysfunction is often absent
Radiographic features
On CT the finding that should not be missed is that of a hyperdense basilar artery. Imaging features are discussed further in the more general article on acute basilar artery occlusion.
Angiography (CT, MR, catheter) can be used to confirm the finding by demonstrating a filling defect.
Differential diagnosis
The pattern of established infarction can be mimicked by:
- artery of Percheron infarct
- bilateral internal cerebral vein thrombosis (dural venous sinus thrombosis)
- other causes of thalamic restricted diffusion
References
- 1. Wijdicks EF. Catastrophic Neurologic Disorders in the Emergency Department. Oxford University Press, USA. (2004) ISBN:0195168801. Read it at Google Books - Find it at Amazon
- 2. Caplan LR. "Top of the basilar" syndrome. Neurology. 1980;30 (1): 72-9. Neurology (citation) - Pubmed citation
- 3. Barkhof F, Valk J. "Top of the basilar" syndrome: a comparison of clinical and MR findings. Neuroradiology. 1988;30 (4): 293-8. - Pubmed citation
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Articles:
Cases:
- Artery of Percheron territory infarct
- Hyperdense basilar tip sign
- Right posterior cerebral artery (PCA) infarct
- Basilar artery occlusion
- Posterior circulation infarct
- Bilateral thalamic infarcts
- Top of basilar syndrome
- Tip of the basilar thrombosis
- Basilar tip thromboembolism
- Top of the basilar syndrome
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- collateral vessel scores
- signs
- by region
- hemispheric infarcts
- frontal lobe infarct
- parietal lobe infarct
- temporal lobe infarct
- occipital lobe infarct
- alexia without agraphia syndrome: PCA
- cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
- Balint syndrome: bilateral PCA
- lacunar infarct
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thalamic infarct
- artery of Percheron infarct
- Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
- top of the basilar syndrome
- striatocapsular infarct
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- cerebellar infarct
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brainstem infarct
- midbrain infarct
- Benedikt syndrome: PCA
- Claude syndrome: PCA
- Nothnagel syndrome: PCA
- Weber syndrome: PCA
- Wernekink commissure syndrome
- pontine infarct
- Brissaud-Sicard syndrome
- facial colliculus syndrome
- Gasperini syndrome: basilar artery or AICA
- inferior medial pontine syndrome (Foville syndrome): basilar artery
- lateral pontine syndrome (Marie-Foix syndrome): basilar artery or AICA
- locked-in syndrome: basilar artery
- Millard-Gubler syndrome: basilar artery
- Raymond syndrome: basilar artery
- medullary infarct
- Babinski-Nageotte syndrome
- Cestan-Chenais syndrome
- hemimedullary syndrome (Reinhold syndrome)
- lateral medullary stroke syndrome (Wallenberg syndrome)
- medial medullary syndrome (Déjerine syndrome)
- Opalski syndrome
- midbrain infarct
- acute spinal cord ischemia syndrome
- hemispheric infarcts
- by vascular territory
- by vessel size
- treatment options
- complications
-
intracranial hemorrhage
-
intra-axial hemorrhage
- signs and formulas
- ABC/2 (volume estimation)
- black hole sign
- blend sign
- cashew nut sign
- CTA spot sign
- island sign
- satellite sign
- swirl sign
- zebra sign
- by type
- by location
- signs and formulas
- extra-axial hemorrhage
- extradural hemorrhage (EDH)
- intralaminar dural hemorrhage
- subdural hemorrhage (SDH)
-
subarachnoid hemorrhage (SAH)
- types
- complications
- grading systems
- subpial hemorrhage
-
intra-axial hemorrhage
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