Basilar imagination : a rare cause of "top of basilar artery" syndrome.

"Top of Basilar Artery" Syndrome as the presentation of CVJ anomalies is extremely rare. The association between skeletal CVJ anomalies and vertebro-basilar insufficiency (VBI) is recognised and angiographic abnormalities of the vertebro-basilar arteries and their branches have been reported. Atlanto-axial dislocation (AAD) is the commonest skeletal cranio-vertebral junction (CVJ) anomaly in India, followed by occipitalisation of atlas and basilar invagination. They usually present with a progressive neurological deficit (70 - 94% cases) implicating the high cervical cord, lower brainstem, and cranial nerves. We report one such case with the even more rare presentation of "Top of Basilar Artery" Syndrome as the initial presentation of basilar invagination.

Prognostic value of GCS and NIHSS in patients with acute top of basilar syndrome / 中国神经精神疾病杂志

Objective To assess the effectiveness of initial Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) as predictors for clinical outcomes in patients with top of the basilar syndrome (TOBS).Methods A total of 64 patients with TOBS were selected from Nanjing Stroke Registration Program (NSRP). Initial GCS and NIHSS were retrospectively evaluated by reviewing patients' records for details of clinical presentation and outcomes at 30 days measured by modified Rankin Scale (mRS) score. Patients were categorized as favorable outcome group (mRS 0-3) and unfavorable outcome group (mRS 4-6).Results The mean GCS was lower in the cases with mRS of 4-6 compared with those with mRS of 0-3 (P<0.01) and the mean NIHSS score was higher in favorable outcome group compared with unfavorable outcome group (P=0.011). In multivariate logistic regression analysis, after adjusting for age, gender and treatment approaches, the GCS OR was 0.301(95% CI 0.167～0.542), NIHSS OR was 1.436(95% CI 1.147～1.796), and both of them turned out to be the independent predictors of outcome at 30 days. ROC curve analysis suggested that GCS score of 10 represented a good cut-off point for predicting the outcome with the prognostic sensitivity of 87.9% and specificity of 83.9%. NIHSS score of 14 could also serve as a good cut-off point with the prognostic sensitivity of 63.6% and specificity of 77.4%.Conclusions Conclusions Both GCS and NIHSS can predict outcomes in patients with acute TOBS with GCS score ≤10 and NIHSS score ≥14 as the cutoff points of poor outcome. GCS cutoff point is more strongly predictive of outcome than that of NIHSS.