{ "schemaVersion": 2, "eyebrow": "Vascular Neurology", "title": "Brainstem Stroke", "summary": "Brainstem stroke requires immediate vascular imaging and reperfusion assessment because minor-appearing cranial nerve, gait, or consciousness findings may represent basilar occlusion, vertebral dissection, or perforator infarction with rapid respiratory, motor, and consciousness deterioration.", "seoDescription": "Point-of-care approach to brainstem stroke: recognize posterior circulation localization, obtain urgent vascular imaging, select reperfusion therapy, and monitor posterior fossa complications.", "clinicalQuestion": "How should clinicians rapidly identify, image, reperfuse, and monitor suspected ischemic brainstem stroke?", "specialty": "Neurology", "audience": "U.S. physicians and medical trainees", "tags": [ "brainstem stroke", "posterior circulation stroke", "basilar artery occlusion", "vertebral artery dissection", "mechanical thrombectomy", "pc-ASPECTS" ], "keyTakeaways": [ "Treat fluctuating brainstem-localizing deficits, reduced consciousness, or acute bilateral motor findings as a posterior-circulation vascular emergency; obtain noncontrast head CT and CTA from the aortic arch through the intracranial circulation without waiting for MRI. [20][22]", "A normal or nondiagnostic noncontrast CT does not exclude posterior-circulation ischemia; CTA identifies basilar occlusion, while diffusion-weighted MRI better establishes acute brainstem and cerebellar infarction. [5][18][22]", "For eligible basilar artery occlusion with baseline mRS 0-1, NIHSS at least 10, pc-ASPECTS at least 6, and presentation within 24 hours, endovascular thrombectomy is recommended in the cited 2026 guidance; benefit for NIHSS below 10 remains uncertain. [18]", "Do not let MRI-defined diffusion abnormality alone preclude urgent reperfusion consideration in posterior circulation stroke, because reversible DWI lesions after reperfusion have been reported. [9]", "Cerebellar infarction requires serial examination for edema-related brainstem compression and herniation; posterior fossa deterioration can follow initially subtle vestibular or gait-predominant presentations. [18]" ], "sections": [ { "id": "recognition-and-immediate-triage", "eyebrow": "First minutes", "heading": "Recognize a brainstem vascular syndrome and activate stroke pathways", "intro": "Localizing findings should override a benign interpretation of dizziness or fluctuating symptoms.", "paragraphs": [ "Activate an acute stroke pathway for abrupt or stuttering diplopia, dysarthria, dysphagia, vertigo with inability to walk, limb or truncal ataxia, nystagmus, extraocular movement abnormality, crossed cranial nerve and long-tract findings, bilateral weakness, or impaired consciousness. Vertebrobasilar TIAs precede posterior-circulation stroke in approximately one-quarter of cases, and fleeting or fluctuating vertebrobasilar symptoms should prompt direct assessment of basilar patency. [15]", "Escalate immediately when consciousness declines, bulbar dysfunction threatens the airway, or examination suggests basilar artery occlusion: acute dysarthria, cranial nerve abnormalities, motor deficits, and altered consciousness are recognized basilar occlusion presentations. Brainstem ischemia can disrupt respiratory, cardiovascular, arousal, and sensorimotor pathways; therefore, stabilize airway and ventilation while obtaining emergent neurovascular imaging rather than observing for symptom evolution. [21][22]", "In younger patients or after trauma, specifically ask about cervical pain or headache. These features, particularly with neurologic deterioration, should raise concern for vertebral artery dissection, which may propagate into the basilar artery or generate distal thromboembolism. [20]" ], "bullets": [ "Document NIHSS, but do not use a low score to dismiss potentially disabling posterior-circulation deficits such as gait failure, ocular motor dysfunction, dysphagia, or depressed arousal. Baseline NIHSS is prognostic in basilar occlusion thrombectomy cohorts. [4]", "Obtain a focused cranial nerve, eye-movement, limb coordination, truncal/gait, motor, sensory, and level-of-consciousness examination before reperfusion treatment when this does not delay imaging or therapy. Brainstem-localizing findings include nystagmus, extraocular movement abnormalities, hearing loss, and crossed findings. [20]", "Treat a rapidly progressive or fluctuating syndrome as potentially proximal basilar disease; distal and mid-basilar occlusions are more often abrupt, whereas proximal occlusions may progress or fluctuate. [15]" ], "subsections": [], "table": { "caption": "Clinical patterns that should redirect evaluation toward a posterior-circulation arterial lesion. [15][20]", "columns": [ "Pattern", "Actionable implication", "Immediate next step" ], "rows": [ [ "Crossed cranial nerve deficit with contralateral long-tract signs", "Localizes to the brainstem and supports posterior-circulation ischemia. [15]", "Obtain emergent CTA to assess vertebral and basilar patency. [22]" ], [ "Fluctuating diplopia, vertigo, ataxia, or impaired sensorium", "May represent vertebrobasilar ischemia or evolving proximal basilar occlusion. [15]", "Do not observe for resolution; perform urgent brain and vascular imaging. [15][22]" ], [ "Neck pain or headache in a younger patient, especially after trauma", "Suggests vertebral artery dissection with possible basilar extension or embolization. [20]", "Image the cervical and intracranial vertebral-basilar circulation. [20][22]" ], [ "Reduced consciousness, bilateral weakness, bulbar deficits", "Raises concern for severe brainstem ischemia or basilar occlusion. [21][22]", "Secure airway as needed and expedite reperfusion-capable stroke-center management. [22]" ] ] } }, { "id": "imaging-and-vessel-confirmation", "eyebrow": "Diagnostic pathway", "heading": "Image the brain and vertebrobasilar circulation without delay", "intro": "The imaging objective is to exclude hemorrhage, establish vessel status, estimate established injury, and identify a reperfusion target.", "paragraphs": [ "Perform immediate noncontrast head CT in suspected acute stroke when thrombolysis or thrombectomy is being considered, when consciousness is depressed, or when bleeding risk is relevant. CT rapidly identifies hemorrhage; however, posterior fossa ischemia may be occult early, so a nondiagnostic CT must not end the evaluation of a brainstem-localizing syndrome. [24][6]", "Add CTA promptly to identify vertebral or basilar arterial occlusion and to distinguish basilar occlusion from isolated small-vessel brainstem infarction. CTA is described as highly accurate for acute basilar artery occlusion, and standard CT plus CTA evaluates key alternatives including hemorrhage and basilar occlusion in suspected acute cerebellar stroke. [5][6]", "Use MRI with diffusion-weighted imaging when it can be obtained without delaying acute reperfusion decisions or when CT/CTA does not explain a persistent focal posterior-circulation syndrome. DWI confirms acute brainstem and cerebellar infarction, while FLAIR hyperintensity within the basilar artery can support suspicion for basilar occlusion in patients with acute brainstem stroke. [18][23]", "Estimate posterior-circulation ischemic injury using pc-ASPECTS when basilar occlusion is being evaluated for thrombectomy. In a stent-retriever thrombectomy cohort, pretreatment DWI pc-ASPECTS of at least 7 versus lower values was associated with outcome, and the cited 2026 guidance uses pc-ASPECTS of at least 6 as part of a basilar-occlusion thrombectomy selection framework. [4][18]" ], "bullets": [ "Interpret a hyperdense basilar artery on noncontrast CT as a strong predictor of basilar thrombosis in a patient with a compatible posterior-circulation syndrome; proceed to CTA rather than relying on the sign alone. [5]", "Consider whole-brain CT perfusion as an adjunct where available, particularly for cerebellar ischemia or uncertain tissue viability; perfusion-deficit volume has been associated with final cerebellar infarct volume. [6]", "Use catheter angiography when proceeding to endovascular treatment or when noninvasive vascular imaging remains uncertain despite a high-probability clinical syndrome. Basilar occlusion may be established by DSA or contrast-enhanced MRA in imaging studies. [23]" ], "subsections": [], "table": { "caption": "Imaging sequence for suspected ischemic brainstem stroke. [5][6][18][22][24]", "columns": [ "Study", "Decision answered", "Interpretation and next action" ], "rows": [ [ "Noncontrast head CT", "Is there intracranial hemorrhage or a hyperdense basilar artery? [5][24]", "Exclude hemorrhage; a hyperdense basilar sign in a compatible syndrome should accelerate CTA. [5]" ], [ "CTA head and neck", "Is there vertebral or basilar occlusion, stenosis, or dissection-related arterial disease? [20][22]", "Confirmed basilar occlusion requires immediate reperfusion assessment and transfer/activation of an endovascular team when indicated. [18][22]" ], [ "MRI brain with DWI and FLAIR", "Is there acute brainstem/cerebellar infarction and supportive evidence of basilar flow abnormality? [18][23]", "Use to define infarct distribution when it will not delay reperfusion; do not assume DWI injury is invariably irreversible in posterior circulation. [9]" ], [ "CT perfusion", "Is there a perfusion deficit and potentially salvageable posterior fossa tissue? [6][24]", "Use as an adjunct for tissue-viability assessment where available; evidence supports association with final cerebellar infarct volume. [6]" ] ] } }, { "id": "etiologic-branches", "eyebrow": "Mechanism directs next steps", "heading": "Separate basilar occlusion, vertebral dissection, large-artery disease, cardioembolism, and perforator infarction", "intro": "Vessel imaging and infarct distribution determine the high-yield etiologic branch.", "paragraphs": [ "A confirmed basilar artery occlusion is the highest-acuity branch. Basilar occlusion commonly reflects thromboembolism, atherosclerotic disease, or dissection and can affect proximal or middle basilar segments. Treat it as a reperfusion decision rather than as a diagnostic endpoint; document occlusion location, infarct burden, NIHSS, premorbid function, and last-known-well time for thrombectomy selection. [22][18]", "When CTA or MRA demonstrates vertebral arterial pathology in a patient with neck pain, headache, trauma, or younger age, prioritize vertebral dissection as the mechanism. Dissection can directly extend into the basilar wall, creating low- or no-flow physiology, or form thrombus that embolizes distally; this explains why cervical vessel imaging is required even when the infarct is intracranial. [20]", "In patients with vascular risk factors and vertebral-basilar stenosis, large-artery atherosclerotic disease becomes more likely. Symptomatic intracranial vertebral and basilar stenosis carries reported annual stroke rates of 8% and 11%, respectively, and vertebrobasilar atherosclerotic stenosis of at least 50% is associated with increased 90-day recurrent stroke risk. [16]", "Cardioembolism remains a major cause of brainstem infarction and basilar occlusion. When CTA demonstrates an abrupt arterial occlusion without a dissection pattern or a clear fixed culprit lesion, pursue a cardiac embolic source as part of the secondary-prevention workup; cardiac evaluation should not delay acute reperfusion treatment. Large-vessel atherosclerosis, small-vessel perforator disease, cardioembolism, and vertebral dissection are leading brainstem infarct mechanisms. [19]", "A small, strategically located pontine, medullary, or midbrain infarct without a large-vessel occlusion shifts the working mechanism toward perforator disease, but serial observation remains necessary because examination can evolve and posterior fossa edema may cause delayed deterioration when cerebellar involvement coexists. [19][18]" ], "bullets": [ "Basilar occlusion: activate neurointerventional evaluation immediately after CTA confirmation. [18][22]", "Suspected dissection: ensure imaging includes cervical vertebral arteries as well as intracranial vertebral-basilar vessels. [20]", "Symptomatic vertebrobasilar stenosis: recognize heightened early recurrence risk and focus subsequent prevention on the identified arterial mechanism. [16]", "No large-vessel lesion: use DWI lesion distribution and vascular risk profile to distinguish perforator disease from embolic patterns. [19]" ], "subsections": [], "table": { "caption": "Etiologic branches in ischemic brainstem stroke. [16][19][20][22]", "columns": [ "Etiology", "Clues that change probability", "Management consequence" ], "rows": [ [ "Basilar artery occlusion", "Altered consciousness, bilateral motor deficits, cranial nerve findings, or CTA-proven basilar obstruction. [22]", "Assess immediately for intravenous thrombolysis and endovascular thrombectomy eligibility. [18][22]" ], [ "Vertebral artery dissection", "Younger age, neck pain, headache, trauma, or cervical vertebral arterial abnormality. [20]", "Define cervical and intracranial extent because dissection can extend into or embolize to the basilar artery. [20]" ], [ "Vertebrobasilar atherosclerotic stenosis", "Documented vertebral or basilar stenosis with vascular risk factors. [16]", "Recognize substantial early and annual recurrent-stroke risk; establish mechanism-specific secondary prevention after acute management. [16]" ], [ "Cardioembolism", "Basilar occlusion or infarct pattern without an explanatory fixed arterial lesion or dissection pattern. [19][22]", "Evaluate for a cardiac embolic source after reperfusion decisions are completed. [19]" ], [ "Perforator small-vessel infarction", "Focal brainstem infarct without large-vessel occlusion, in the appropriate vascular-risk context. [19]", "Manage as ischemic stroke while maintaining surveillance for clinical evolution or unrecognized posterior fossa involvement. [18][19]" ] ] } }, { "id": "reperfusion-and-acute-management", "eyebrow": "Revascularization", "heading": "Deliver reperfusion therapy for eligible ischemic brainstem stroke", "intro": "Basilar occlusion should trigger parallel assessment for intravenous thrombolysis and thrombectomy.", "paragraphs": [ "For acute ischemic stroke with confirmed basilar artery occlusion, evaluate immediately for intravenous thrombolysis within the applicable licensed treatment window and do not delay thrombectomy transfer or activation to complete treatment response assessment. NICE recommends thrombectomy with intravenous thrombolysis when not contraindicated and within the licensed window, as soon as possible for proximal posterior-circulation occlusion demonstrated by CTA or MRA. [24]", "The cited 2026 basilar-occlusion selection framework recommends endovascular thrombectomy within 24 hours for patients with baseline mRS 0-1, NIHSS at least 10, and pc-ASPECTS at least 6. For NIHSS below 10, thrombectomy effectiveness has not been established in that guidance; involve a comprehensive stroke center rather than treating low apparent severity as proof of low risk. [18]", "Do not use extensive posterior-circulation DWI signal as an automatic reason to withhold reperfusion without expert review. DWI lesions are commonly used as a surrogate for irreversible core, but posterior-circulation cases have demonstrated sustained lesion reversal after intravenous thrombolysis and endovascular reperfusion. [9]", "For wake-up or unknown-onset ischemic stroke, MRI-based selection can identify patients for thrombolysis when imaging demonstrates an acute DWI lesion without corresponding FLAIR hyperintensity in the cited trial framework. Apply this approach within an institutional acute-stroke protocol and in parallel with CTA-based large-vessel-occlusion assessment. [3]" ], "bullets": [ "Give thrombolytic therapy only through a protocol capable of managing post-thrombolysis complications with acute stroke and neuroradiology support. [24]", "Use CTA or MRA confirmation of proximal posterior-circulation occlusion before thrombectomy selection. [24]", "Record premorbid mRS, NIHSS, pc-ASPECTS, occlusion site, and last-known-well time before endovascular consultation; these variables directly inform basilar-occlusion selection and prognosis. [4][18]", "If airway protection is required because of declining consciousness or bulbar failure, intubate without delaying reperfusion-team mobilization. Brainstem injury can compromise arousal and respiratory control. [21]" ], "subsections": [ { "heading": "Prognostic information that should not delay treatment", "paragraphs": [ "Baseline neurologic severity and pretreatment posterior-circulation infarct burden are important prognostic markers after thrombectomy. In a cohort of 50 acute basilar occlusion patients treated with stent-retriever thrombectomy, age, hypertension, baseline NIHSS, DWI pc-ASPECTS, thalamic infarction, and bilateral thalamic infarction were associated with outcome; DWI pc-ASPECTS and initial stroke severity were independent predictors. [4]" ], "bullets": [ "Use prognostic imaging to inform counseling and procedural planning, not as a reason to postpone vascular imaging or neurointerventional consultation. [4][18]" ] } ], "table": { "caption": "Acute reperfusion decisions in suspected ischemic brainstem stroke. [3][18][24]", "columns": [ "Clinical-imaging state", "Treatment decision", "Key limitation" ], "rows": [ [ "CTA/MRA-confirmed proximal posterior-circulation occlusion within 6 hours", "Offer thrombectomy as soon as possible, with intravenous thrombolysis when not contraindicated and within its licensed window. [24]", "Treatment requires immediate imaging confirmation and stroke-center capability. [24]" ], [ "Basilar occlusion up to 24 hours, baseline mRS 0-1, NIHSS at least 10, pc-ASPECTS at least 6", "Proceed with endovascular thrombectomy under the cited 2026 selection framework. [18]", "Evidence of effectiveness is not established for NIHSS below 10. [18]" ], [ "Wake-up or unknown-onset ischemic stroke with MRI DWI-FLAIR mismatch", "Consider MRI-guided intravenous thrombolysis within an established acute-stroke protocol. [3]", "MRI acquisition must not delay CTA and endovascular assessment when large-vessel occlusion is suspected. [3][24]" ], [ "Posterior-circulation DWI lesions before reperfusion", "Obtain expert reperfusion review rather than presuming all DWI abnormality is irreversible. [9]", "Evidence for DWI reversal consists of limited posterior-circulation reports. [9]" ] ] } }, { "id": "monitoring-and-complications", "eyebrow": "Post-acute surveillance", "heading": "Monitor for airway failure, evolving basilar syndrome, and posterior fossa mass effect", "intro": "Neurologic stability after imaging or reperfusion does not eliminate posterior fossa risk.", "paragraphs": [ "Admit patients with acute brainstem or cerebellar infarction to a setting capable of frequent neurologic and respiratory reassessment. Worsening arousal, new cranial nerve or bulbar deficits, evolving quadriparesis, or abnormal respiratory pattern should prompt immediate reevaluation for infarct progression, recurrent vascular occlusion, hemorrhagic transformation, or posterior fossa mass effect. Brainstem injury can disrupt respiratory and cardiovascular control, and cerebellar edema can produce brainstem compression or herniation. [21][18]", "For cerebellar involvement, maintain a low threshold for repeat brain imaging when headache, vomiting, declining consciousness, or new focal deficits emerge. Cerebellar infarction is high-risk because edema develops within the confined posterior fossa, and management may require intervention for hydrocephalus or mass effect. [18][15]", "After the acute phase, anchor secondary prevention to the demonstrated mechanism rather than labeling the event nonspecifically. Identify vertebral-basilar atherosclerotic disease, vertebral dissection, cardioembolism, or perforator disease from vascular imaging, infarct distribution, and cardiac assessment; symptomatic vertebrobasilar atherosclerotic disease is particularly important because recurrence risk is elevated early after the index event. [16][19][20]" ], "bullets": [ "Repeat focused examinations of consciousness, pupils and eye movements, bulbar function, limb strength, coordination, and gait when safe; changes in these domains can signal posterior circulation progression. [20][21]", "Escalate immediately for neurosurgical evaluation when posterior fossa swelling produces hydrocephalus or brainstem compression; ventriculoperitoneal shunting has been used for hydrocephalus in vertebrobasilar dolichoectasia-related compression syndromes, illustrating the need for CSF-diversion assessment when obstructive hydrocephalus develops. [15]", "Do not defer etiologic testing solely because deficits improve after reperfusion: vertebral dissection, atherosclerotic stenosis, and cardioembolism carry different recurrent-stroke implications. [16][19][20]" ], "subsections": [], "table": { "caption": "Deterioration triggers after brainstem or cerebellar infarction. [18][21]", "columns": [ "Change", "Concern", "Immediate action" ], "rows": [ [ "Declining consciousness or abnormal respirations", "Brainstem dysfunction, expanding infarction, or posterior fossa compression. [18][21]", "Stabilize airway and obtain urgent repeat neurologic assessment and brain imaging. [18][21]" ], [ "New dysphagia, dysarthria, ocular motor deficit, or weakness", "Evolving brainstem ischemia or recurrent/progressive vertebrobasilar compromise. [20][22]", "Repeat vascular and parenchymal imaging based on clinical trajectory. [22]" ], [ "Headache, vomiting, or decline after cerebellar infarction", "Cerebellar edema, hydrocephalus, brainstem compression, or herniation. [18]", "Obtain urgent brain imaging and involve neurosurgical services when mass effect or hydrocephalus is identified. [18][15]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "1 Free State Reporting, Inc. 1378 Cape St. Claire Road ...", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/98713/download", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 2, "title": "united states of america", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/123223/download", "authors": "www.fda.gov", "host": "www.fda.gov" }, { "number": 3, "title": "MRI-Guided Thrombolysis for Stroke with Unknown Time of ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa1804355", "authors": "www.nejm.org", "host": "www.nejm.org" }, { "number": 4, "title": "Predictors of Good Outcome After Stent-Retriever Thrombectomy in Acute Basilar Artery Occlusion | Stroke", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/STROKEAHA.115.010840?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 5, "title": "Hyperdense Basilar Artery Sign on Unenhanced CT Predicts Thrombus and Outcome in Acute Posterior Circulation Stroke | Stroke", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.108.516690?doi=10.1161%2FSTROKEAHA.108.516690", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 6, "title": "Incremental Value of Computed Tomography Perfusion for Final Infarct Prediction in Acute Ischemic Cerebellar Stroke", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/JAHA.119.013069", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 7, "title": "AHA/ASA Journals", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000513?download=true", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 8, "title": "Vertebral Artery Stenosis - 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "1 Free State Reporting, Inc. 1378 Cape St. Claire Road ...", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/98713/download", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "is the one Dr. Chaturvedi was mentioning, I think, with the craniotomy, who then had strokes. DR. CHATURVEDI: The one with the primary hemorrhage, yeah. DR. NOONAN: Yes. And so maybe vasospasm was a cause. I mean, he did have a hemorrhage. I don't know. You didn't tell me if it was subarachnoid hemo", "score": 0.22607414 }, { "number": 2, "title": "united states of america", "detail": "www.fda.gov", "url": "https://www.fda.gov/media/123223/download", "authors": "www.fda.gov", "host": "www.fda.gov", "snippet": "157 consider the 8% in general, so I'd like to point out that I would tend to be more interested in the periprocedural risk of stroke, which is 6.67. It's subtle, but it is different. If you look at the patient population, there's 65 that are 59 years old, 65% have hypertension, 44% smoke, so there ", "score": 0.17856912 }, { "number": 3, "title": "MRI-Guided Thrombolysis for Stroke with Unknown Time of ...", "detail": "www.nejm.org", "url": "https://www.nejm.org/doi/full/10.1056/NEJMoa1804355", "authors": "www.nejm.org", "host": "www.nejm.org", "snippet": "by G Thomalla · 2018 · Cited by 1719 — Other types include occlusion of the anterior or posterior cerebral artery and the vertebral or basilar artery. CT perfusion imaging in wake-up", "score": 0.46366343 }, { "number": 4, "title": "Predictors of Good Outcome After Stent-Retriever Thrombectomy in Acute Basilar Artery Occlusion | Stroke", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/STROKEAHA.115.010840?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "We analyzed clinical and pretreatment diffusion-weighted imaging (DWI) data in 50 consecutive patients with acute basilar artery occlusion treated with stent-retriever thrombectomy. In a univariate analysis, the following variables were significantly associated with outcome: age, hypertension, basel", "score": 0.60077465 }, { "number": 5, "title": "Hyperdense Basilar Artery Sign on Unenhanced CT Predicts Thrombus and Outcome in Acute Posterior Circulation Stroke | Stroke", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/strokeaha.108.516690?doi=10.1161%2FSTROKEAHA.108.516690", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Our purpose was to determine whether the hyperdense basilar artery (HDBA) sign has utility in detecting thrombosis and predicting outcome in patients presenting with signs and symptoms of posterior circulation stroke. The following variables were correlated with short-term and long-term outcome by u", "score": 0.5962692 }, { "number": 6, "title": "Incremental Value of Computed Tomography Perfusion for Final Infarct Prediction in Acute Ischemic Cerebellar Stroke", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/JAHA.119.013069", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Incremental Value of Computed Tomography Perfusion for Final Infarct Prediction in Acute Ischemic Cerebellar Stroke | Journal of the American Heart Association. In acute cerebellar stroke, perfusion deficit volumes in whole‐brain computed tomography perfusion imaging are associated with final cerebe", "score": 0.5148644 }, { "number": 7, "title": "AHA/ASA Journals", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/pdf/10.1161/STR.0000000000000513?download=true", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Stroke e316 August 2026 Stroke. 2026;57:e316–e436. DOI: 10.1161/STR.0000000000000513 CLINICAL STATEMENTS AND GUIDELINES 2026 Guideline for the Early Management of Patients With", "score": 0.10113599 }, { "number": 8, "title": "Vertebral Artery Stenosis - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/nursing-and-health-professions/vertebral-artery-stenosis", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Vertebral Artery Stenosis - an overview\nIt is also known as rotational VA occlusion syndrome, for it is a mechanical occlusion of the vertebral artery that leads to a reduction in blood flow in the posterior cerebral circulation resulting in transient reversible symptomatic vertebrobasilar in", "score": 0.6538572 }, { "number": 9, "title": "DWI lesions reversal in posterior circulation stroke after reperfusion: Two illustrative cases and review of the literature - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0150986115000504", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: DWI lesions reversal in posterior circulation stroke after reperfusion: Two illustrative cases and review of the literature - ScienceDirect\n# Correspondence DWI lesions reversal in posterior circulation stroke after reperfusion: Two illustrative cases and review of the literature. In acute is", "score": 0.59457535 }, { "number": 10, "title": "Impact of Etiology, Thrombectomy Techniques, and Lesion ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1002/brb3.70612", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by HA Eryilmaz · 2025 — Acute basilar artery occlusion (BAO) is a rare but clinically significant condition that can lead to ischemia in the brainstem, occipital lobes", "score": 0.36718005 }, { "number": 11, "title": "Poster Presentations", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1111/dmcn.15477", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Basilar artery occlusion (BAO)/Stroke (BAS) in children is rare, accounting for approximately 1% of strokes. Symptoms range from hemiparesis, involuntary", "score": 0.2545627 }, { "number": 12, "title": "Clinical Vignettes Abstracts", "detail": "shmpublications.onlinelibrary.wiley.com", "url": "https://shmpublications.onlinelibrary.wiley.com/doi/pdf/10.1002/jhm.331", "authors": "shmpublications.onlinelibrary.wiley.com", "host": "shmpublications.onlinelibrary.wiley.com", "snippet": "A mass was visualized in the pericardial space along with stroke when administered within 3 to 6 hours of the onset of symptoms. indication to thrombolytic use,", "score": 0.19200887 }, { "number": 13, "title": "Canadian Stroke Best Practice Recommendations ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/ijs.12551", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by LK Casaubon · 2015 · Cited by 255 — Labetalol is recommended as a first-line treatment for acute blood pressure management if there are no contraindications [Evidence Level B].", "score": 0.17917156 }, { "number": 14, "title": "Guidelines", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/ijs.12551", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by LK Casaubon · 2015 · Cited by 254 — This includes assessment, diagno- sis with the support of early neurovascular imaging, thrombolysis or endovascular interventions for acute ischemic stroke,", "score": 0.14607534 }, { "number": 15, "title": "Ischemic Posterior Circulation Stroke: A Review of Anatomy, Clinical Presentations, Diagnosis, and Current Management", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC3985033", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "PMC Copyright notice\n\nPMCID: PMC3985033 PMID: 24778625\n\n## . In contrast to the anterior circulation, several differences in presenting symptoms, clinical evaluation, diagnostic testing, and management strategy exist presenting a challenge to the treating physician. This review will discuss the anat", "score": 0.71305263 }, { "number": 16, "title": "Vertebral Artery Interventions: A Comprehensive Updated Review", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10201878", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Posterior circulation ischemic stroke has an estimated prevalence of 20% to 25% . Vertebral arterial occlusion in patients with known atherosclerotic peripheral artery disease (PAD) has a 40% incidence of vertebral artery stenosis (VAS). In the New England Medical Center Posterior Circulation Regist", "score": 0.6824261 }, { "number": 17, "title": "A Review of Endovascular Treatment for Posterior Circulation Strokes", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10318221", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "32.Nouh A, Remke J, Ruland S. Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. _Front Neurol_. 2014. 5:30. doi: 10.3389/fneur.2014.00030 [DOI] [PMC free article] [PubMed] [Google Scholar]\n 33.Ahmed RA, Dmytriw AA, Patel AB, Stap", "score": 0.6609831 }, { "number": 18, "title": "Cerebellar Infarction - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK470416", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "The 2026 guidelines recommend EVT for AIS caused by basilar artery occlusion with a baseline mRS score of 0 to 1, NIHSS score of 10 or higher, and PC-ASPECTS of 6 or more (mild ischemic damage on CT), within 24 hours of symptom onset. However, the effectiveness of EVT in patients with NIHSS scores ", "score": 0.64182705 }, { "number": 19, "title": "Brainstem Stroke - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK560896", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Brainstem infarctions result from loss of oxygen supply to any of these territories and account for nearly one-third of all ischemic strokes. Pontine infarctions are the most common, whereas medullary infarctions account for approximately 7% of ischemic brainstem strokes, with lateral medullary (Wal", "score": 0.63750535 }, { "number": 20, "title": "Basilar Occlusion Syndromes: An Update - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4530423", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Basilar artery occlusion (BAO) is a potentially fatal diagnosis, yet it is one of the most challenging conditions for clinicians to diagnose and manage. Posterior circulation strokes account for about 15% to 20% of all ischemic strokes. The BAO is a subset of this category, representing 1% to 4% of ", "score": 0.6364215 }, { "number": 21, "title": "Vertebrobasilar Stroke - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK556084", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Vertebrobasilar artery stroke involves ischemic or hemorrhagic injury to the posterior cerebral circulation, which supplies the brainstem, cerebellum, thalamus, occipital lobes, and portions of the temporal lobes. Because the brainstem regulates respiration, cardiovascular function, arousal, and cri", "score": 0.5928793 }, { "number": 22, "title": "Basilar Artery Occlusion - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK532241", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "BAO represents a rare but life-threatening form of posterior circulation stroke with high morbidity and mortality. The condition results from thromboembolism, atherosclerotic disease, or vascular dissection, most often affecting the proximal or middle segments of the basilar artery. Clinical present", "score": 0.5455042 }, { "number": 23, "title": "Hyperintense Basilar Artery on FLAIR MR Imaging: Diagnostic Accuracy and Clinical Impact in Patients with Acute Brain Stem Stroke | American Journal of Neuroradiology", "detail": "www.ajnr.org", "url": "https://www.ajnr.org/content/35/8/1520", "authors": "www.ajnr.org", "host": "www.ajnr.org", "snippet": "# Hyperintense Basilar Artery on FLAIR MR Imaging: Diagnostic Accuracy and Clinical Impact in Patients with Acute Brain Stem Stroke. The diagnostic accuracy of the FLAIR-hyperintense basilar artery sign was tested by 4 independent readers in a case-control design, and the relation among FLAIR-hyperi", "score": 0.6755297 }, { "number": 24, "title": "Recommendations | Stroke and transient ischaemic attack in over 16s: diagnosis and initial management | Guidance | NICE", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/ng128/chapter/recommendations", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume \n \ntaking into account the factors in recommendation 1.4.8 (see additional information). \n\n##### 1.4.7\n\nConsider thrombectomy together", "score": 0.54245186 } ], "publishedAt": "2026-08-21T02:34:22.292212+00:00", "updatedAt": "2026-08-21T02:34:22.292212+00:00", "readingMinutes": 8, "slug": "brainstem-stroke" }