Neurologist-in-training

Abstract

The missed "top of the basilar" syndrome may be the most catastrophic event in a patient's and doctor's career. It must be assumed to be a common event anywhere leading to significant disability and death. This is due to a great variability of symptom presentation e.g., coma, somnolence, waking-sleep disturbances, visual disturbances, hallucinations, agitation, delirium and memory dysfunction, etc. The reason is a chiefly embolic obstruction of the distal basilar artery, the P1 arteries or their branches e.g., the different thalamic branches. MRI provides the best early diagnosis. Therapy must be introduced as soon as possible and patients should be transferred to a stroke centre providing adequate treatment.