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Review
. 2014 Apr 7:5:30.
doi: 10.3389/fneur.2014.00030. eCollection 2014.

Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management

Amre Nouh  1 , Jessica Remke  2 , Sean Ruland  1
Affiliations
Review

Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management

Amre Nouh et al. Front Neurol. .

Abstract

Posterior circulation strokes represent approximately 20% of all ischemic strokes (1, 2). In contrast to the anterior circulation, several differences in presenting symptoms, clinical evaluation, diagnostic testing, and management strategy exist presenting a challenge to the treating physician. This review will discuss the anatomical, etiological, and clinical classification of PC strokes, identify diagnostic pitfalls, and overview current therapeutic regimens.

Keywords: basilar artery; posterior circulation; stroke; stroke management; vertebral artery.

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Figures

Figure 1
Figure 1
Vertebrobasilar system. PCA, posterior cerebral artery; SCA, superior cerebral artery; BA, basilar artery; AICA, anterior inferior cerebellar artery; PICA, posterior inferior cerebellar artery; V1–V4, segments of the vertebral artery. Proximal territory, areas supplied by the intracranial VAs and PICAs up to the VB junction; middle territory, BA and AICAs up to the SCAs; distal territory, rostral BA, SCAs, and PCAs.
Figure 2
Figure 2
(A) Hypoplastic right vertebral artery (bottom arrow); basilar artery displacement opposite to the dominant vertebral artery (top arrow); (B) incomplete circle of Willis, absent left posterior communicating artery (bottom arrow), absent left A1 segment (top arrow); (C) fenestration of the basilar artery (bottom arrow); hypoplastic right P1 segment (top arrow) and (D) posterior cerebral artery arising directly from the internal carotid artery (fetal variant, arrow).
Figure 3
Figure 3
(A) MRI fluid-attenuated inversion recovery (FLAIR) sequence showing a right lateral medullary infarction in a 32-year-old woman with a hypoplastic right vertebral artery shown in Figure 2A; (B) catheter angiogram of a 55-year-old African-American man showing atherostenosis at the vertebrobasilar junction (arrow); (C) non-contrast CT showing a left posterior cerebral artery territory infarction in a 60-year-old man with atrial fibrillation; (D) catheter angiogram showing a right distal vertebral dissecting aneurysm with intraluminal thrombus (arrow) in a 19-year-old man presenting with vertigo, ataxia, and a right cerebellar infarction.
Figure 4
Figure 4
(A) MRI diffusion-weighted image (DWI) demonstrating a right ventral pontine infarction (arrow) in a 62-year-old man with fluctuating left sided weakness; (B) MRI-DWI showing a small dorsal left medullary infarction (arrow) in a 58-year-old man with hypertension and hyperlipidemia presenting with acute isolated vertigo; (C) catheter angiogram showing cut-off of the right posterior inferior cerebellar artery (arrow); (D,E) MRI-DWI showing massive right cerebellar hemispheric and vermian infarction; (F) MRI T2-weighted sequence demonstrating right cerebellar infarction with edema and mass effect.
See this image and copyright information in PMC

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