Abstract
Posterior circulation stroke (PCS), caused by infarction within the vertebrobasilar arterial system, is a potentially life-threatening condition and accounts for about 20–25% of all ischemic strokes. Diagnosing PCS can be challenging due to the vast area of brain tissue supplied by the posterior circulation and, as a consequence, the wide range of—frequently non-specific—symptoms. Commonly used prehospital stroke scales and triage systems do not adequately represent signs and symptoms of PCS, which may also escape detection by cerebral imaging. All these factors may contribute to causing delay in recognition and diagnosis of PCS in the emergency context. This narrative review approaches the issue of diagnostic error in PCS from different perspectives, including anatomical and demographic considerations as well as pitfalls and problems associated with various stages of prehospital and emergency department assessment. Strategies and approaches to improve speed and accuracy of recognition and early management of PCS are outlined.
Highlights
Physicians long viewed posterior circulation stroke (PCS) as an entity sufficiently distinct from anterior circulation stroke (ACS) to justify focusing on particulars of management rather than attempting to identify stroke etiology and deriving therapeutic recommendations [1]
Despite advancing knowledge about PCS, rates of misdiagnosis still exceed those in ACS, which is related to several functional-anatomical properties of the posterior circulation and the clinical consequences resulting from acute vascular pathology
While the general nature of stroke in the anterior and posterior circulation is similar in many respects, there are distinct anatomical differences between the carotid and the vertebrobasilar vascular anatomy contributing to some of the differences in the way PCS is conceptually approached
Summary
Physicians long viewed posterior circulation stroke (PCS) as an entity sufficiently distinct from anterior circulation stroke (ACS) to justify focusing on particulars of management rather than attempting to identify stroke etiology and deriving therapeutic recommendations [1]. The initiation of the New England Medical Center Posterior Circulation Registry (NEMC PCR) in 1988 constituted a critical turning point, as this research provided a large body of new clinical and imaging information which challenged this historical view and emphasized that PCS and ACS were, more alike than they were different. Despite advancing knowledge about PCS, rates of misdiagnosis still exceed those in ACS, which is related to several functional-anatomical properties of the posterior circulation and the clinical consequences resulting from acute vascular pathology. These inherent characteristics lead to several challenges concerning the correct recognition and diagnosis of PCS in the emergency department
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