Von Leyden’s Contribution to the Elusive Syndrome of Acute Basilar Artery Occlusion

By Eelco F. M. Wijdicks
First Online: 09 February 2021

Early recognition of acute basilar artery embolus has remained problematic, and clinical signs are not commonly interpreted as dire. The syndrome, despite its familiar (textbook) clinical presentation, historically has remained elusive even for seasoned physicians and even now [1]. Pathologists―if they meticulously examined the often accidentally torn brainstem vasculature ―were well aware of occlusions of the basilar artery as early as the 1900s. One of first descriptions of basilar artery occlusion,albeit with a protracted stuttering course rather than an acute one, is most likely by the Scottish physician John Abercrombie in his 1834 book, Pathological and Practical Researches on Disease of the Brain and the Spinal Cord [2]. This observation was recently summarized in a historical article [3]. Abercrombie describes an 18-year-old man with left hemiplegia followed one month later by loss of speech and dysphagia; at autopsy, he observed a blocked basilar artery filled by “a firm white matter without any appearance of blood.” The diagnosis was considered “plugging of the basilar.”

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