What is the role of CT scanning of the head in the workup of basilar artery thrombosis?

Updated: Jan 11, 2019
  • Author: Salvador Cruz-Flores, MD, MPH, FAHA, FCCM, FAAN, FACP, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Computed tomography (CT) scanning is usually the first imaging study performed. [6] It has a sensitivity of greater than 95% for identifying hemorrhage within the first 24 hours of onset and helps to exclude intra- or extra-axial hemorrhage.

However, CT scanning has a low sensitivity for early ischemia and usually has the disadvantage of significant artifacts caused by the bony structures surrounding the brainstem and cerebellum.

Helpful findings include infarcts in the thalamus and/or occipital lobe or lobes, which indicate involvement of the rostral basilar artery; a hyperdense basilar artery, which indicates probable occlusion [7] ; and a dilated vertebral and/or basilar artery, which indicates a dolichoectatic vessel. (See the image below.) [8]

Spiral CT angiography is helpful in identifying occluded and dolichoectatic vessels. CT angiogram should be helpful in assisting treatment decision making. (See the image below.) [9]

Hyperdense basilar artery (arrow). Hyperdense basilar artery (arrow).
Spiral CT angiography showing occluded basilar art Spiral CT angiography showing occluded basilar artery.

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