Background: Current knowledge on primary or isolated basilar artery dissection (IBAD) is limited to case vignettes and small patient series. Objective: To delineate the frequency and clinical presentations of IBAD along with short-term outcome, specific prognosis and targeted management. Methods: Data were derived from a series of 12 consecutive patients and a review of 88 cases reported in the literature. In all the cases, the dissection was confined to the basilar artery. Results: Disease incidence was estimated at 0.25 per 100,000 person-years. IBAD accounted for roughly 1.0% of all subarachnoid hemorrhage events and for no less than 10.5 and 4.5% of posterior circulation and brain-supplying artery dissections, respectively. The main clinical presentations were subarachnoid hemorrhage (46%) and posterior circulation brain ischemia (42%). Subarachnoid hemorrhage typically manifested at a higher age than brain ischemia (mean age, 48.9 vs. 41.4 years) and was more prevalent among women. Rebleedings related to pseudoaneurysm formation in patients with subarachnoid hemorrhage and recurrent ischemia in stroke patients were common in the acute phase (26.1 and 33.3%, respectively) but were rare in the long term. The outcome was generally favorable in stroke patients but variable in subarachnoid hemorrhage (case fatality rate, 21.7%). The mainstay of therapy for subarachnoid hemorrhage related to IBAD was endovascular occlusion of the aneurysm pouch whereas stroke patients were usually put on anticoagulants. Conclusions: IBAD is probably an underrecognized disease with heterogeneous clinical presentation and prognosis. It should be considered as a differential diagnosis in peritruncal subarachnoid hemorrhage, classic subarachnoid hemorrhage and posterior circulation stroke, especially in young individuals. Case management is challenging and has to be tailored to each patient.

Caplan LR: Dissections of brain-supplying arteries. Nat Clin Pract Neurol 2008;4:34–42.
Schievink WI, Mokri B, O’Fallon WM: Recurrent spontaneous cervical-artery dissection. N Engl J Med 1994;330:393–397.
Schievink WI: Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001;344:898–906.
Kim BM, Suh SH, Park SI, et al: Management and clinical outcome of acute basilar artery dissection. AJNR Am J Neuroradiol 2008;29:1937–1941.
Pozzati E, Andreoli A, Padovani R, et al: Dissecting aneurysms of the basilar artery. Neurosurgery 1995;36:254–258.
Ali MJ, Bendok BR, Tella MN, et al: Arterial reconstruction by direct surgical clipping of a basilar artery dissecting aneurysm after failed vertebral artery occlusion: technical case report and literature review. Neurosurgery 2003;52:1475–1480.
Goyal MS, Derdeyn CP: The diagnosis and management of supraaortic arterial dissection. Curr Opin Neurol 2009;22:80–89.
Takagi M, Hirata K, Fujitsu K, et al: Unusual angiographic changes in a dissecting aneurysm of the basilar artery: case report. Neurosurgery 1994;34:356–358.
Masson C, Krespy Y, Masson M, et al: Magnetic resonance imaging in basilar artery dissection. Stroke 1993;24:1264–1266.
Woimant F, Spelle L: Spontaneous basilar artery dissection: contribution of magnetic resonance imaging to diagnosis. J Neurol Neurosurg Psychiatry 1995;58:540.
Leclerc X, Godefroy O, Salhi A, et al: Helical CT for the diagnosis of extracranial internal carotid artery dissection. Stroke 1996;27:461–466.
Urbach H, Meyer-Lindenberg A, Bendszus M, et al: Dissections of the basilar artery (in German). Rofo 1998;169:170–174.
Joo IS, Lee JS: Dissecting aneurysm of the basilar artery as a cause of orgasmic headache. Headache 2005;45:956–959.
Van de Kelft E, Kunnen J, Truyen L, et al: Postpartum dissecting aneurysm of the basilar artery. Stroke 1992;23:114–116.
Scazzeri F, Mascalchi M, Calabrese R, et al: Case report. MRI and MR angiography of basilar artery dissection in a child. Neuroradiology 1997;39:654–657.
Arnold M, Bousser MG, Fahrni G, et al: Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 2006;37:2499–2503.
Arunodaya GR, Vani S, Shankar SK, et al: Fibromuscular dysplasia with dissection of basilar artery presenting as ‘locked-in-syndrome’. Neurology 1997;48:1605–1608.
Kulla L, Deymeer F, Smith TW, et al: Intracranial dissecting and saccular aneurysms in polycystic kidney disease. Arch Neurol 1982;39:776–778.
Patroclo CB, Puglia P Jr, Leite Cda C, et al: Endovascular treatment of a basilar artery dissecting aneurysm. Arq Neuropsiquiatr 2007;65:1012–1014.
Hosoda K, Fujita S, Kawaguchi T, et al: Spontaneous dissecting aneurysms of the basilar artery presenting with subarachnoid hemorrhage. J Neurosurg 1991;75:628–633.
Adams HP Jr, Aschenbrener CA, Kassell NF, et al: Intracranial hemorrhage produced by spontaneous dissecting intracranial aneurysm. Arch Neurol 1982;39:773–776.
Farrell MA, Gilbert JJ, Kaufman JC: Fatal intracranial arterial dissection: clinical pathological correlation. J Neurol Neurosurg Psychiatry 1985;48:111–121.
Endo S, Nishijima M, Nomura H, et al: A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage: report of three autopsied cases and review of the literature. Neurosurgery 1993;33:732–738.
Kim CH, Son YJ, Paek SH, et al: Clinical analysis of vertebrobasilar dissection. Acta Neurochir (Wien) 2006;148:395–404.
Rabinstein AA: The AHA Guidelines for the Management of SAH: what we know and so much we need to learn. Neurocrit Care 2009;10:414–417.
Amin-Hanjani S, Ogilvy CS, Buonanno FS, et al: Treatment of dissecting basilar artery aneurysm by flow reversal. Acta Neurochir (Wien) 1997;139:44–51.
O’Shaughnessy BA, Getch CC, Bendok BR, et al: Late morphological progression of a dissecting basilar artery aneurysm after staged bilateral vertebral artery occlusion: case report. Surg Neurol 2005;63:236–243.
Alexander CB, Burger PC, Goree JA: Dissecting aneurysms of the basilar artery in 2 patients. Stroke 1979;10:294–299.
Mizutani T: A fatal, chronically growing basilar artery: a new type of dissecting aneurysm. J Neurosurg 1996;84:962–971.
Yoshimoto Y, Hoya K, Tanaka Y, et al: Basilar artery dissection. J Neurosurg 2005;102:476–481.
Ross GJ, Ferraro F, DeRiggi L, et al: Spontaneous healing of basilar artery dissection: MR findings. J Comput Assist Tomogr 1994;18:292–294.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.