Childhood basilar artery occlusion: a report of 5 cases and review of the literature

Abstract

Basilar artery occlusion has poor outcome in adults; little is known regarding outcomes in children. Whether intra-arterial treatments improve adult outcomes is controversial. Safety and efficacy of intra-arterial treatments in children are unknown. We report 5 cases of basilar artery occlusion and review published cases. We estimated National Institute of Health Stroke Scale (NIHSS) and modified Rankin Score (mRS) of published cases, compared scores between non-intra-arterial treatments and intra-arterial treatments groups, and examined the correlation between NIHSS and mRS. Of our cases, 4 had good outcomes and 1 died. Of 63 published cases, 45 had no intra-arterial treatments and 18 had intra-arterial treatments. In the non-intra-arterial treatments group 24 had good outcomes. In the intra-arterial treatments group 13 had good outcomes. There was strong correlation between the NIHSS and the mRS. Children with basilar artery occlusion have better outcomes than adults. Certain children with basilar artery occlusion may be treated conservatively. A registry for childhood basilar artery occlusion is urgently needed.

Keywords: National Institute of Health Stroke Scale; basilar artery occlusion; intra-arterial treatment; modified Rankin Score; thrombolysis..

Figure 1

Magnetic resonance imaging (MRI) with diffusion sequence for case 1. White and black arrow pointing to the restricted diffusion in the right and left cerebellar hemispheres, respectively, indicating acute infarct.

Figure 2

Magnetic resonance angiogram (MRA) for case 1. Large white arrows pointing to vertebral arteries, small white arrows showing no flow in distal basilar artery indicating distal basilar artery occlusion, black arrow heads indicating middle cerebral arteries, and white arrow heads pointing to anterior cerebral arteries.

Figure 3

Magnetic resonance imaging (MRI) with diffusion sequence for case 2. White arrow pointing to the right cerebellar hemisphere with restricted diffusion and black arrow pointing to the cerebellar vermis with restricted diffusion indicating acute infarct.

Figure 4

Conventional angiogram for case 2. Large black arrow pointing to aneurysmal dissection of the V3 segment of the left vertebral artery, small black arrow pointing to left posterior inferior cerebellar artery, and white arrow showing no flow into the basilar artery indicating complete basilar artery occlusion.

Figure 5

Magnetic resonance imaging (MRI) with diffusion sequence for case 3. White arrow pointing to restricted diffusion in left anterior pons indicating acute infarct.

Figure 6

Conventional angiogram after contrast injection into left vertebral artery (VA) for case 3. Large black arrow—left VA; small black arrow—large left posterior inferior cerebellar artery (PICA); white large arrow—right VA after reflux of contrast from the left VA; small white arrow—right PICA after reflux of contrast from the left VA; and black arrow head—showing no flow into the proximal basilar artery, indicating basilar artery occlusion.

Figure 7

Histogram depicting modified Rankin Scores sorted by group. Group 1, no intra-arterial interventions; group 2, intra-arterial interventions. Abbreviations: IAT, intra-arterial treatment.

Figure 8

Histogram depicting National Institute of Health Stroke Scale scores sorted by group. Group 1, no intra-arterial interventions; group 2, intra-arterial interventions.

Figure 9

Scatterplot of National Institute of Health (NIH) Stroke Scale versus modified Rankin Score (MRS). The bolder circles indicate multiple cases per data point.