Temporal profile of vertebrobasilar territory infarction. Prognostic implications.

Abstract

SUMMARY To determine the type and prognostic significance of the various temporal profiles of vertebrobasilar territory infarction, 39 consecutive patients were studied.The following temporal profiles were identified: 1) coma from onset, 5 patients; 2) sudden onset followed by stabilization, 12 patients; 3) gradual onset reaching stabilization within 24 hours, 7 patients; 4) gradual onset with progression beyond 24 hours, 2 patients, and; 5) delayed worsening after stabilization, 13 patients. Patients in Group 1 and those with unstable courses, Groups 4 and 5, had poor outcomes with mortality of 100 and 27 percent, respectively. Mortality for Groups 2 and 3 was 5 percent Overall, hospital mortality was 25.6 percent.Demographic data, risk factors, presenting symptoms and type of neurologic deficit, other than coma, had no correlation with mortality, degree of disability and long term survival. At follow up of 6 to 52 months, median 24, only 7 percent of the survivors had recurrent cerebrovascular events; 2 patients (7%) died due to nonvascular causes and 72 percent of patients re-examined (20 of 28) were either neurologicaJly normal or had only minimal deficits.

Clinical profile and prognosis of patients with posterior circulation stroke

“…Study by Patrick et al found that most common clinical presentation was cranial nerve involvement was 64%, followed by altered sensorium (47%). 9 Kora et al study found most common presentation as motor disturbance and altered sensorium (63%) patients. In posterior circulation stroke is due to the involvement of cerebellum or its connections.…”

“…8 Patrick et al showed a mortality of 25.6%. 9 Jone et al study showed mortality of 27.5%. 16 Kora et al study showed mortality of 26.3%.…”

Stroke-in-progression.

“…15 Jones, Millikan and Sandok reported 37 cases examined between 1967 and 1969. 9 Patrick, Ramirez-Lassepas and Snyder reported 22 clinical cases collected from 1975 to 1978 with CT. 23 Irino et al reported 2 clinical cases with serial angiography and CT. 5 Thus at the present time, clinical data can be based on 62 patients with carotid artery infarction, 48 of whom had no CT and on the data from 47 patients with vertebrobasilar infarctions 23 of whom had no CT. Thorough clinico-pathological reports are available for patients with 3 vertebrobasilar and 1 carotid lesion.…”

“…Occlusions of large arteries Atherosclerotic thrombosis of large arteries is generally held as the main cause of progressing stroke 3 ' 5 -9 -l5 ' 23 but the former equation stroke-in-evolution = thrombosis-inevolution is no longer warranted. 4 Cardiac embolism can also cause a stroke-in-progression.…”

“…9 Patrick, Ramirez-Lassepas and Snyder concluded that instability and late exacerbations can be expected even for as long a 7 days after the onset of symptoms. 23 In the progressing strokes reported by Irino et al (13 carotid, 2 vertebrobasilar) worsenings occurred from the 3rd to the 16th day. Thus 18 to 24 hours without progression in the carotid system and 72 hours in the vertebrobasilar system are probably not safe margins of time for the end diagnosis.…”