Reversible Rostral Basilar Artery Syndrome

We prospectively studied 34 patients with clinical and radiologic evidence of rostral basilar artery syndrome, a vasoocclusive disorder, who had uniformly excellent short-term functional recovery, in marked contrast to the classic syndrome. All patients displayed important neurobehavioral disturbances, including an acute confusional state, necessitating medical consultation. The composite group had minimal hypertension, significant arrhythmias in the young, and no history of vertebrobasilar insufficiency. Unsuspected cases of idiopathic orthostatic hypotension, as well as cardiac arrhythmias in the elderly, were discovered. A vascular cause was not considered in 79% of those presenting for emergency evaluation and prevented proper acute diagnostic evaluation in 88%. Recognition of this potentially reversible cerebrovascular syndrome may prevent hazardous diagnostic and therapeutic interventions.