Occipital Infarctions Associated with Hemiparesis

Johansson, Tor

doi:10.1159/000115807

Cited by 9 publications

(5 citation statements)

References 12 publications

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“…However, motor deficits were observed in 19 % of our patients (transient or minor in most), although no lesion other than s-PCAI was demonstrated by CT or MRI. In accordance with our results, Johansson et al [14] described hemiparesis without brainstem symptoms in 24 % of CT-identified occipital infarcts, suggesting involvement of the PCA perforating branches. Steinke et al [36] reported motor weakness in 20 % of s-PCAIs.According to Zeal and Rhoton [43], direct PCA perforating branches often arise from the P2 segment, indicating a possible association between cortical infarction and hypoperfusion of the posterior internal capsule.…”

Section: Discussionsupporting

confidence: 93%

Pure superficial posterior cerebral artery territory infarction in The Lausanne Stroke Registry

Cals¹,

Devuyst²,

Afşar³

et al. 2002

Journal of Neurology

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Section: Discussionsupporting

confidence: 93%

Pure superficial posterior cerebral artery territory infarction in The Lausanne Stroke Registry

Cals¹,

Devuyst²,

Afşar³

et al. 2002

Journal of Neurology

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“…All PCAs originated from the basilar tip. Most patients (117/90%) were admitted directly and had a median NIHSS of 7 (IQR, [3][4][5][6][7][8][9][10][11][12]. Premorbid disability (mRS > 2) was present in 22 (16.9%) of patients, and the median premorbid mRS was 1 (range, 0-4).…”

Section: Resultsmentioning

confidence: 99%

“…Here, perforating arteries originating proximally provide supply to the cerebral peduncle and dorsolateral thalamus. Nevertheless, motor deficits are reported only in about 30% of acute, isolated posterior cerebral artery (PCA) occlusion (7)(8)(9). Therefore, we investigated whether EVT can have beneficial effects on immediate and long-term functional outcome in patients with AIS caused by primary, isolated occlusion of the PCA in comparison to best medical management (BMM), with or without concomitant thrombolysis.…”

Section: Introductionmentioning

confidence: 99%

Mechanical Thrombectomy in Isolated Occlusion of the Proximal Posterior Cerebral Artery

et al. 2021

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Introduction: Endovascular therapy (EVT) is established as first-line treatment for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the anterior circulation. For basilar artery occlusion, recent randomized clinical trials demonstrated not only equipoise but also advantages for EVT under particular circumstances. It remains unclear whether EVT offers an advantage over best medical management (BMM) including thrombolysis (IVT) in isolated occlusion of the proximal posterior cerebral artery (PCAO).Methods: Patients with AIS due to PCAO proven by CT or MR angiography were retrospectively identified from local databases at four comprehensive stroke centers in Germany, USA, and Taiwan between 2012 and 2020. Demographic and clinical data were collected, and imaging characteristics including pretherapeutic, interventional, and follow-up imaging were reviewed locally at each center. Patients were grouped according to therapy, i.e., BMM including IVT alone vs. BMM and EVT. Efficacy endpoints were early neurological improvement (ENI) after 24 h or at discharge, good outcome (modified Rankin scale 0–2) after 3 months, as well as hemorrhagic complications and in-house deaths as safety endpoints.Results: We included 130 patients of whom 23 (17.7%) received EVT. EVT patients had more proximal occlusions (69.9 vs. 43%, p = 0.023) and had a better premorbid function [premorbid mRS, 0 (0–4) vs. 1 (0–3), p < 0.01] when compared to BMM patients. IVT showed a trend toward being less performed in the EVT group (21.7 vs. 41.1%, p = 0.1), while other baseline parameters were balanced. Successful reperfusion was achieved in 52% of EVT patients. ENI was more frequent in the EVT group (61 vs. 35.5%, p = 0.034). Good outcome at 90 days and safety endpoints did not differ. In a bivariate analysis, ENI was independently predicted by the use of EVT (OR, 2.76; CI, 1.055–7.04) and the baseline National Institutes of Health Stroke Scale (NIHSS) (OR, 1.082; CI, 1.027–1.141 per point increase).Discussion: EVT in isolated PCAO appears safe and feasible. Positive effects on clinical outcome are primarily on ENI but also depend on the initial stroke severity. Further prospective or randomized studies are needed to better describe the potential long-term clinical benefits of EVT for PCAO as compared with best medical management.

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“…Occurrence of motor deficits with PCA territory ischemia is considered unusual [30]. However, in the series of Brandt et al [7]in 28% of patients a mostly transient and slight hemiparesis was seen similar to the series of Johansson [31], who reported this finding in 17/71 (24%) of patients, with occipital infarcts and no brainstem symptoms. Recently, Milandre et al [4]described a motor deficit in 28/82 (34%) patients with PCA infarcts, involving, however, an exceptionally high proportion of deep PCA territory infarcts.…”

Section: Clinical Featuresmentioning

confidence: 93%

“…Pathoanatomic correlation to the motor deficits could not be made in the series of Johansson [31]with PCA infarcts exclusively verified by CT scan. In the series of Brandt et al [7]18 of 31 patients with motor deficits and PCA territory infarcts had a thalamocapsular infarct on CT scan, in 7 patients only detected by MRI; an infarct of the cerebral peduncle in the midbrain was shown by MRI in 2 of 4 patients with persistent severe hemipareses (fig.…”

Section: Infarct Topography and Clinical Findingsmentioning

confidence: 97%

Posterior Cerebral Artery Territory Infarcts: Clinical Features, Infarct Topography, Causes and Outcome<footref rid="foot01"><sup>1</sup></footref>

et al. 2000

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Only a few large series of posterior cerebral artery (PCA) stroke exist, and clinical features and causes have not been studied as extensively as in other vascular territories. The PCA syndrome includes more clinical signs than the well-known visual field deficits. Concomitant findings are frequently sensory, slight motor and neuropsychological deficits. Unilateral headaches are the common presenting symptom making complicated migraine an important differential diagnosis. Combined deep and superficial PCA territory infarcts involving the lateral thalamus are more frequent than commonly assumed and are mostly associated with sensory and reversible slight motor deficits. Occlusion of the precommunal PCA segment with associated paramedian midbrain infarction causes severe motor deficits, oculomotor signs, and decreased consciousness and has a poorer outcome than other PCA territory infarcts. Embolism from a cardiac or undetermined source is the leading mechanism accounting for up to half of the cases, whereas arterial embolism from significant proximal vertebrobasilar disease is less frequent. Local atherothrombotic stenosis or occlusion of the PCA is uncommon. In spite of thorough diagnostic evaluation, the etiology of PCA territory infarction cannot be determined in at least one quarter of patients. Among the rare causes of PCA territory infarction carotid artery disease is important while the significance of migraine remains controversial.

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Occipital Infarctions Associated with Hemiparesis

Cited by 9 publications

References 12 publications

Pure superficial posterior cerebral artery territory infarction in The Lausanne Stroke Registry

Pure superficial posterior cerebral artery territory infarction in The Lausanne Stroke Registry

Mechanical Thrombectomy in Isolated Occlusion of the Proximal Posterior Cerebral Artery

Posterior Cerebral Artery Territory Infarcts: Clinical Features, Infarct Topography, Causes and Outcome<footref rid="foot01"><sup>1</sup></footref>

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