MEGADOLICHO BASILAR ARTERY - RELEVANCE FOR NEUROLOGICAL INTENSIVE-CARE AS AN INDICATOR OF BRAIN-STEM ISCHEMIA

An ectasia and enlargement of the basilar artery by a fusiform aneurys m is called megadolicho basilaris. We report five cases with this cond ition identified at our clinic since 1989, reflecting an incidence of 0,05 percent (5/9300 scans). All patients presented with an acute brai nstem syndrome (medullary in 2, pontine in 1 and pontomedullary in 2 p atient). With one exception, all cases required intensive care due to respiratory insufficiency. Two patients died, one required total care, and two patients made a good recovery, one of these under therapeutic anticoagulation. All but one patient experienced additional episodes of cerebrovascular ischemia before or after presentation. Vascular ris k factors were found in four patients. The detection of a megadolicho basilaris identifies a patient subgroup that is highly prone to verteb robasilar ischemia and therefore of high significance for neurological intensive care medicine. Recurrence rate for ischemia is high. While even a severe brainstem syndrome may be reversed under anticoagulation in the individual case, presence of multiple vascular risk factors of ten prevents the employment of this treatment modality.