Posterior circulation ischaemic stroke

Abstract

Summary pointsPosterior circulation stroke accounts for 20-25% (range 17-40%) of ischaemic strokes Posterior circulation transient ischaemic attacks may include brief or minor brainstem symptoms and are more difficult to diagnose than anterior circulation ischaemia Specialist assessment and administration of intravenous tissue plasminogen activator are delayed in posterior circulation stroke compared with anterior circulation strokeThe risk of recurrent stroke after posterior circulation stroke is at least as high as for anterior circulation stroke, and vertebrobasilar stenosis increases the risk threefold Acute neurosurgical input may be needed in patients with hydrocephalus or raised intracranial pressure Basilar occlusion is associated with high mortality or severe disability, especially if blood flow is not restored in the vessel; if symptoms such as acute coma, dysarthria, dysphagia, quadriparesis, pupillary and oculomotor abnormalities are detected, urgently seek the input of a stroke specialist Sources and selection criteriaWe searched PubMed up to November 2013 with the terms "posterior circulation," "stroke," "ischaemic," and "vertebrobasilar," targeting full text English language studies published since 1990. We also searched the reference lists of the identified articles and our own files. Only papers published in English, or with an English abstract, were reviewed. The final selection of references was based on our judgment of relevance to the topic of this review.to Fabry's disease, a rare X linked inherited multisystem lysosomal storage disorder. 16 Similar to other forms of cerebrovascular and cardiovascular disease, the risk factors for posterior circulation strokes include hypertension, smoking, hypercholesterolaemia, atrial fibrillation, and coronary artery disease. What are the clinical symptoms and signs of posterior circulation ischaemia?Posterior circulation ischaemia can be challenging to recognise, particularly in patients with a TIA, which may have resolved by the time of presentation. However, there are some characteristic clinical patterns (box 1).Because the posterior circulation supplies the brainstem, cerebellum, and occipital cortex, symptoms often include dizziness, diplopia, dysarthria, dysphagia, disequilibrium, ataxia, and visual field deficits. Acute onset "crossed" deficits-cranial nerve territory symptoms on one side and sensory or motor deficits of the opposite arm and leg-are virtually diagnostic of posterior circulation ischaemia. 7 In a large single centre observational study of 407 patients, the most common posterior circulation symptoms were dizziness (47%), unilateral limb weakness (41%), dysarthria (31%), headache (28%), and nausea or vomiting (27%). The most common signs were unilateral limb weakness (38%), gait ataxia (31%), unilateral limb ataxia (30%), dysarthria (28%), and nystagmus (24%). 18In a large Chinese registry observational study of patients with posterior or anterior circulation stroke on confirmed magnetic resonance imaging, the signs with the highest...

Posterior circulation ischaemic stroke

“…Posterior circulation ischaemic stroke causes about 20% of ischaemic strokes and affects more than 20 000 people each year in the UK 23. The New England Medical Center Posterior Circulation Registry (NEMC-PCR)4 provides useful demographic data on those experiencing posterior circulation stroke (defined using brain imaging): patients had a mean age of 60.5 years; 63% were men, and approximately a quarter (24%, n=98) had a preceding transient ischaemic attack 4…”

Posterior Circulation Ischemic Stroke Caused by Arterial Dissection: Characteristics and Predictors of Poor Outcomes

“…Several studies have shown that posterior circulation ischemic stroke (PCS) differs from anterior circulation ischemic stroke in many ways, including stroke mechanisms [2][3][4] . Despite its importance, the amount of studies on PCS is disproportionably fewer than that on anterior circulation ischemic stroke.…”

“…Conscious change independently predicted mortality at 3 months. Quadriparesis, National Institutes of Health Stroke Arterial dissection (AD) is reported more frequently as the etiology in PCS than in anterior circulation ischemic stroke [2,3,5] . We recently reported that PCS is a heterogeneous disease, and one-fourth of PCS were caused by AD (AD-PCS) [6] .…”

Urgent decisions and a tight spot: embolic infarction of a herniated cerebellar tonsil

“…Recent studies have suggested that sensitivity CT may be approaching 100% if performed in the first 6–12 hours after onset of symptoms of subarachnoid haemorrhage2 and thus lumbar puncture may not be necessary if a serious caution or contraindication exists 3. MR is clearly the investigation of choice in a case such as this, where a patient presents with acute neurological signs suggestive of a potential posterior circulation stroke 4 5. However, MR remains unavailable outside standard working hours in many hospitals 6.…”