Neurologists describe most feared and devastating strokes

January 10, 2013

Among the most feared and devastating strokes are ones caused by blockages in the brain's critical basilar artery system. When not fatal, basilar artery strokes can cause devastating deficits, including head-to-toe paralysis called "locked-in syndrome."

However, a minority of patients can have good outcomes, especially with new MRI technologies and time-sensitive treatments. These treatments include the clot-busting drug (tPA), and various new-generation neurothrombectomy devices, according to a review article in MedLink Neurology by three Loyola University Medical Center neurologists.

About 85 percent of strokes are ischemic, meaning they are caused by blockages in blood vessels. (The remaining strokes are caused by bleeding in the brain.) About 4 percent of all are caused by blockages in the basilar artery system. The basilar artery supplies oxygen-rich blood to some of the most critical .

The first clinical description of a basilar artery stroke was reported in 1868, according to the MedLink article, which was written by Loyola neurologists Sarkis Morales Vidal, MD, (first author); Murray Flaster, MD, PhD; and Jose Biller, MD; and edited by Steven R. Levine, MD, of the SUNY Health Science Center.

A character in Alexandre Dumas' novel, "The Count of Monte Cristo," described as a "corpse with living eyes," had what appears to be locked-in syndrome. More recently, the book and movie "The Diving Bell and the Butterfly" describe a French journalist with locked-in syndrome. The journalist was mentally intact, but able to move only his left eyelid. He composed a moving memoir by picking out one letter at a time as the alphabet was slowly recited.

The MedLink article reports that an estimated 80 percent of locked-in patients live for at least five years, and some patients have survived for more than 20 years. One survey of long-term survivors found that 86 percent reported their attention level was good, 77 percent were able to read and 66 percent could communicate with eye movements and blinking. Forty-eight percent reported their mood was good.

The review article cites a study of basilar artery stroke patients that found that a month after the stroke, one-third of patients were dead and one-third needed help for activities of daily living such as bathing, dressing and eating.

Most basilar artery strokes are caused by atherosclerosis (hardening of the arteries). The second-leading cause is clots.

Leading risk factors for basilar artery strokes are high blood pressure, diabetes, smoking, high cholesterol, coronary artery disease and peripheral vascular disease. Affected individuals tend to be over age 50. Basilar artery strokes are more common in men than in women.

Explore further: 1 in 7 strokes occurs during sleep, many go without clot-busting treatment

Related Stories

The Medical Minute: Stroke awareness

May 30, 2011

A stroke is sudden brain injury caused by a sudden vascular (blood vessel) compromise. There are two major types of strokes. An ischemic stroke occurs when blood flow to a part of the brain is blocked by clot or other debris. ...

The Medical Minute: Solitaire for stroke -- It's not a game

May 22, 2012

Stroke is the fourth leading cause of death in North America -- down from third. Despite this "improvement," stroke remains the leading cause of adult disability. Ischemic strokes, caused by blood vessel blockages, are by ...

Recommended for you

New insights on how cocaine changes the brain

November 25, 2015

The burst of energy and hyperactivity that comes with a cocaine high is a rather accurate reflection of what's going on in the brain of its users, finds a study published November 25 in Cell Reports. Through experiments conducted ...

Can physical exercise enhance long-term memory?

November 25, 2015

Exercise can enhance the development of new brain cells in the adult brain, a process called adult neurogenesis. These newborn brain cells play an important role in learning and memory. A new study has determined that mice ...

Umbilical cells help eye's neurons connect

November 24, 2015

Cells isolated from human umbilical cord tissue have been shown to produce molecules that help retinal neurons from the eyes of rats grow, connect and survive, according to Duke University researchers working with Janssen ...

Brain connections predict how well you can pay attention

November 24, 2015

During a 1959 television appearance, Jack Kerouac was asked how long it took him to write his novel On The Road. His response – three weeks – amazed the interviewer and ignited an enduring myth that the book was composed ...

No cable spaghetti in the brain

November 24, 2015

Our brain is a mysterious machine. Billions of nerve cells are connected such that they store information as efficiently as books are stored in a well-organized library. To this date, many details remain unclear, for instance ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.