Top of the basilar 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 ischaemia due to occlusion of perforator vessels.

Clinically, top of the basilar syndrome is characterised by:

  • visual and oculomotor deficits
  • behavioural abnormalities
  • somnolence, hallucinations and dreamlike behaviour
  • motor dysfunction is often absent

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.

The pattern of established infarction can be mimicked by:

Stroke and intracranial haemorrhage
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Article information

rID: 6257
Section: Syndromes
Synonyms or Alternate Spellings:
  • Top of the basilar artery syndrome
  • Tip of the basilar syndrome

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