Vertebro-Basilar Embolism

By the turn of the 20th century, neurological clinicians had already come to the notion that occlusive lesions in the posterior circulation were usually thrombotic, that is due to insitu thrombosis of arteries previously damaged by degenerative atherosclerotic changes. Gowers wrote in 1903 'A woman aged 60 was brought unconscious to the hospital with symptoms that pointed to obstruction in the basilar artery. Of the two lesions that seemed possible, atheromatous thrombosis and embolism, the rarity of the latter made the brmer more likely. She died and thrombosis of the basilar artery was found as anticipatedl.' The idea that embolism is not common in the posterior circulation has persisted for nearly a century. Herein, I plan to review data from my own experience and that of others that suggest that embolism is and always was a common, albeit neglected, cause of posterior circulation infarcts.