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.
Highlights
Subtle hypodensities, loss of gray–white matter differentiation and sulcal effacement have been used to asses for signs of early ischemia on non-contrast head CT
Applying the pc-Alberta Stroke Program Early CT Score (ASPECTS) score to MRIDWI has been shown to be a powerful marker for the prediction of functional outcome of PC stroke [68]
Despite the superior sensitivity of MRI-DWI in detection of PC stroke compared to CT, MRI can rarely be negative for small infarctions [19]
Summary
INCOMPLETE CIRCLE OF WILLIS AND THE FETAL PCA An incomplete COW is present in 48–58% of the population [6] (Figure 2B). The most common intracranial site of atherostenosis is the BA, followed by the ICAs, MCAs, VAs, PCAs, and ACAs. Intracranial stenosis is more prevalent among African-American and Asian individuals and may account for a higher rate of strokes in these populations compared to Caucasians (Figure 3B). Intracranial stenosis is more prevalent among African-American and Asian individuals and may account for a higher rate of strokes in these populations compared to Caucasians (Figure 3B) Neurovascular imaging techniques such as endovascular ultrasound and high resolution MRI have shown both vulnerable atherosclerotic plaques and fibroproliferative lesions [25]. The Hallym stroke registry (HSR) reported large artery stenosis in nearly half of 591 Korean patients with PC strokes, intrinsic small vessel disease in a third, and only 11% had potential cardiac sources of embolism. The frequency of common presenting signs and symptoms of PC infarcts from the www.frontiersin.org
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