The Neuro-Ophthalmologic Spectrum of the Rostral Basilar Artery Syndrome

A broad range of neuro-ophthalmologic signs occurs with the rostral basilar artery syndrome (RBAS) and transient ischemia or infarction of the midbrain, thalamus, hypothalamus, paramedian diencephalon, and posterior temporal and occipital lobes. The pattern of affected neuroanatomic regions results in diverse patterns of interrelated functional disabilities in the areas of vertical gaze, nystagmus, oculomotor function, pupillary reactivity, visual fields, color vision, and visual illusions. With increasing recognition of more clinically benign forms of RBAS, it has become apparent that the vascular syndrome is often improperly diagnosed and may be associated with remediable occult medical disorders. To facilitate the acquisition of accurate diagnostic and therapeutic information, neuro-ophthalmologic signs were prospectively assessed in 61 patients with RBAS. The clinicoanatomic correlates of these diverse ocular manifestations are presented.