Intraluminal clot in the vertebrobasilar Circulation

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Abstract
We studied 15 patients with angiographically documented intraluminal clot in the vertebrobaeilar (VB) circulation and ischemic stroke. Progressive brainetem signs were the most common presentation; the neurologic deficit was maximum at stroke onset in 4. Seven experienced their first symptom during sedentary activities. Thirteen of the initial 15 CTs revealed infarcts in the VB temtory, 7 with multiple foci. Intraluminal clot was present in the vertebral artery in 7 patients (2 bilateral), bash artery in 7, posterior cerebral artery in 5, and superior cerebellar artery in 1. Multiple clots were seen in 5 patients. Stroke risk factors were present in the majority of cases. Although cardiac source embolism was the moat common single etiology (4 patients), most patients had other causes including migraine, coagulopathy associated with malignancy and nephritic syndrome in systemic lupus erythematosus, vertebral artery dissection with local embolism, delayed irradiation arteriopathy, and a bursiform, ectatic bask artery. Six (40%) died within 5 months of follow-up. Intraluminal clot in the posterior circulation is a marker for multiple stroke mechanism, not all of which are embolic. Intraluminal clot should prompt investigations into occult risk factors when no cause appears obvious.