Top of the basilar syndrome apparently due to vertebral artery dissection Case report

The patient, a 47-year-old male had a long history of hypertension, first noted pain in the back of his head on July 14, 1991. On July 17, he suddenly lost consciousness and was admitted. Upon admission the patient was semicomatose, his right eye deviated to the left, the “doll's head eye phenomenon” was absent, his pupils were constricted bilaterally, and the reaction to light and the corneal reflex were absent. His both upper extremities were atonic and his both lower extremities were spastic. Deep tendon reflexes were normal in both upper extremities and hyperactive in both lower extremities. The Babinski sign was positive biliaterally. A head CT scan examined immediately after admission was normal. Cerebral angiography which was done 2 hours after the onset revealed irregular narrowed segment with tapering from the V3 portion of both vertebral arteries (VA) to their transition into the basilar artery and an existence of embolus shadow defect at the top of the basilar artery. There were no atherosclerotic changes of internal carotid arteries. On the second day, a CT scan and MRI revealed infarctions of the cerebellum, pons, midbrain, the bilateral thalamus, and the left occipital lobe. He was suggested that his symptoms were due to vertebral arteries dissection. This is the first reported case about the top of the basilar syndrome due to vertebral artery dissection.