Posterior Cerebral Artery Infarction Research Articles

Impact of early physiotherapy intervention in managing homonymous hemianopia due to posterior cerebral artery infarct—a case report

Homonymous hemianopia field loss can develop as a result of injury to any part of the retro chiasmal visual pathway and is frequently fatal for subjects. The most common cause of homonymous hemianopia in older persons is ischemic infarction of the occipital lobe and its causes are multifactorial, frequently providing a diagnostic challenge to the clinician and signaling the necessity for a thorough systemic health review. Hemianopia is a loss of half of the visual field in each eye in which the inner or nasal half of one eye and the outer or temporal half of the other eye is affected. We report a case of a 72-year-old male subject who visited our department with complaints of weakness on the right side with difficulty seeing on the right side for 3 days. After undergoing various investigations, it was found that there is an acute infarct in the posterior cerebral artery territory supplying the left medial temporal lobe, medial occipital lobe, left thalamus, and splenium of the corpus callosum. After a physiotherapeutic examination provisionally, he was diagnosed with right hemiparesis and homonymous hemianopia, and thus, we administered an early physical therapy intervention which was found to be effective.

Amnesia, Superior Altitudinal Anopia, and Reversed Clock Phenomenon due to Bilateral Posterior Cerebral Artery Infarcts.

Amnesia, Superior Altitudinal Anopia, and Reversed Clock Phenomenon due to Bilateral Posterior Cerebral Artery Infarcts.

Study the carotid Doppler and computed tomography of head in ischemic stroke patients

Background: A stroke is an episode of acute neurological dysfunction from either ischemic infarction or a collection of blood within the brain or ventricular system with resultant focal injury of the central nervous system. The estimated global incidence of stroke is 2–3/1000 person-years, with older patients and patients with carotid artery stenosis or atrial fibrillation having the highest risk. Hence, carotid studies may help with early prevention and management in patients. Aims and Objectives: We aimed to study the prevalence of carotid artery stenosis in acute ischemic stroke and the association of risk factors. Materials and Methods: This was a descriptive study conducted in the department of internal medicine over a period of 6 months. It was carried out in 125 ischemic stroke patients’ inpatient departments. The ischemic stroke was established with history, examination, and computed tomography (CT) with carotid color Doppler study for percentage of stenosis. Results: The 47 (37.6%) stroke patients had carotid stenosis <50% and 78 (62.4%) had >50%; out of them, 32% (40) had (≥50–69%) stenosis, 24% (30) exhibited 70–99%, and 6.4% (8) reported total occlusion. In the CT brain, lacunar infarcts were found in 42 (33.6%), normal and middle cerebral artery infarcts in 27 (21.6%), anterior cerebral artery infarcts in 17 (13.6%), and posterior cerebral artery infarcts in 12 (9.6%). In clinical profiles, 75 (60%) patients presented with right-sided hemiparesis, 50 (40%) with left-sided hemiparesis, 62 (49.6%) with loss of consciousness, 28 (22.4%) with dizziness, and 31 (24.8%) with motor aphasia. Conventional risk factors include hypertension in 68 (54.4%), diabetes in 39 (31.2%), dyslipidemia in 58 (46.4%), heart disease in 65 (52%), and smoking in 51 (40.8%). In the present study, the majority of patients found carotid stenosis >50%, lacunar infarcts were the most common CT findings, and right hemiparesis was common paresis. Hypertension was the most common risk factor among others, and all were significant (P<0.05) for the stroke. Conclusion: There is a high prevalence of carotid stenosis, with >50% in ischemic stroke patients with hypertension being the most common risk factor.

Predictors of atrial fibrillation detection in embolic stroke of undetermined source patients with implantable loop recorder.

Covert atrial fibrillation (AF) is a predominant aetiology of embolic stroke of undetermined source (ESUS). Evidence suggested that AF is more frequently detected by implantable loop recorder (ILR) than by conventional monitoring. However, the predictive factors associated with occult AF detected using ILRs are not well established yet. In this study we aim to investigate the predictors of AF detection in patients with ESUS undergoing an ILR. This observational multi-centre study included consecutive ESUS patients who underwent ILR implantation. The infarcts were divided in deep, cortical infarcts or both. The infarction sites were categorized as anterior and middle cerebral artery, posterior cerebral artery with and without brainstem/cerebellum involvement. Multivariable logistic regression analysis was performed to investigate variables associated with AF detection. Overall, 3,000 patients were initially identified. However, in total, 127 patients who consecutively underwent ILR implantation were included in our analysis. AF was detected in 33 (26%) out of 127 patients. The median follow-up was 411 days. There were no significant differences in clinical characteristics and comorbidities between patients with and without AF detected. AF was detected more often after posterior cerebral artery infarct with brainstem/cerebellum involvement (p < 0.001) whereas less often after infarction in the anterior and middle cerebral artery (p = 0.021). Multivariable regression analysis demonstrated that posterior cerebral artery infarct with brainstem/cerebellum involvement was an independent predictor of AF detection. Our study showed that posterior circulation infarcts with brainstem/cerebellum involvement are associated with AF detection in ESUS patients undergoing ILR. Larger prospective studies are needed to validate our findings.

Endovascular Embolization of Traumatic Vessel Injury Using N-butyl Cyanoacrylate: A Case Series.

There is limited evidence of N-butyl cyanoacrylate (n-BCA) use in endovascular embolization of traumatic face and neck vessel injuries. We investigated the safety and effectiveness of n-BCA for this purpose. We retrospectively analyzed consecutive patients presenting to a Level 1 trauma center between April 2021 and July 2022. We included patients aged ≥ 18years old with any vessel injury in the face and neck circulation requiring n-BCA embolization. The primary endpoint was n-BCA effectiveness defined as immediate control of active bleeding post-embolization. In total, 13 patients met the inclusion criteria. The median decade of life was 3 (IQR 3 - 5) with a male predominance (n = 11, 84.6%). Median Glasgow Coma Scale score on presentation was 15 (IQR 3-15). Eleven patients suffered gunshot wound injuries; two patients suffered blunt injuries. Injured vessels included facial artery (n = 6, 46.2%), buccal branch artery (n = 3, 23.1%), internal maxillary (n = 5, 38.5%), cervical internal carotid artery (n = 1, 7.7%), and vertebral artery (n = 1, 7.7%). All patients were treated with 1:2 n-BCA to ethiodol mixture with immediate extravasation control. No bleeding recurrence or need for retreatment occurred. One patient died in-hospital (7.7%). Patients were discharged to home (n = 8, 61.5%), day rehabilitation (n = 1, 7.7%), or acute rehabilitation (n = 3, 23.1%). One patient developed a right posterior cerebral artery infarct with hemorrhagic transformation. To our knowledge, this is the first study demonstrating the safety and effectiveness of n-BCA liquid embolism in traumatic vessel injuries, especially penetrating gunshot wounds.

Pearls for the Emergency Clinician: Posterior Circulation Stroke

BackgroundPosterior circulation (PC) stroke in adults is a rare, frequently misdiagnosed, serious condition that carries a high rate of morbidity. Objective of the ReviewThis review evaluates the presentation, diagnosis, and management of PC stroke in the emergency department (ED) based on current evidence. DiscussionPC stroke presents most commonly with dizziness or vertigo and must be distinguished from more benign diagnoses. Emergency clinicians should consider this condition in patients with dizziness, even in younger patients and those who do not have traditional stroke risk factors. Neurologic examination for focal neurologic deficit, dysmetria, dysarthria, ataxia, and truncal ataxia is essential, as is the differentiation of acute vestibular syndrome vs. spontaneous episodic vestibular syndrome vs. triggered episodic vestibular syndrome. The HINTS (head impulse, nystagmus, and test of skew) examination can be useful for identifying dizziness presentations concerning for stroke when performed by those with appropriate training. However, it should only be used in patients with continuous dizziness who have ongoing nystagmus. Contrast tomography (CT), CT angiography, and CT perfusion have limited sensitivity for identifying PC strokes, and although magnetic resonance imaging is the gold standard, it may miss some PC strokes early in their course. Thrombolysis is recommended in patients presenting within the appropriate time window for thrombolytic therapy, and although some data suggest endovascular therapy for basilar artery and posterior cerebral artery infarcts is beneficial, its applicability for all PC strokes remains to be determined. ConclusionsAn understanding of PC stroke can assist emergency clinicians in diagnosing and managing this disease.

Middle cerebral artery dynamic cerebral autoregulation is impaired by infarctions in the anterior but not the posterior cerebral artery territory in patients with mild strokes.

The aim of this study was to ascertain whether dynamic cerebral autoregulation (CA) in the middle cerebral artery (MCA) is disturbed by cerebral infarctions outside the MCA territory. We estimated transfer function parameters gain and phase from simultaneous recordings of spontaneous oscillation in blood pressure and MCA cerebral blood flow velocity in 10 consecutive patients with isolated anterior cerebral artery (ACA) infarctions and in 22 consecutive patients with isolated posterior cerebral artery (PCA) infarctions. All ACA infarctions were in the motor, premotor, or supplementary motor cortex areas and presented with pronounced leg hemiparesis. Twenty-eight age- and sex-matched healthy subjects served as controls. Compared to controls, phase was significantly reduced in the MCA ipsilateral to the lesion site and in the contralateral MCA (unaffected hemisphere) in the very low (0.02-0.07 Hz) and low (0.07-0.15 Hz) frequency ranges in the ACA infarctions but not in the PCA infarctions. Gain was reduced only in the very low frequency range in the MCA contralateral to the ACA lesion site. Systemic factors were unrelated to phase and gain results. Bilateral impairment of MCA dynamic CA in patients with a unilateral ACA infarction is frequent.

Efficacy of Prolonged Impella 5.5 Support as Bridge to Heart Transplantation: Current Concepts and Future Direction.

To the Editor: Zaky et al.1 recently published an interesting article titled, “Impella 5.5 Support beyond 50 Days as Bridge to Heart Transplant in End-Stage Heart Failure Patients” that demonstrated efficacy of the Impella 5.5 regarding its ability to provide adequate prolonged hemodynamic support and maintain durability in four cases. The four patients presented in cardiogenic shock with a history of heart failure with or without chronic kidney disease. Due to contraindications to left ventricular assist device use, they received Impella 5.5 support for a mean duration of 70 days (range 54–83). All patients were able to ambulate by day 6, with the only device malfunction being loss of placement signal in one patient and the only complication being bilateral posterior cerebral artery infarcts of unknown cause in another patient. All four patients had devices with intact pump function on explantation and underwent successful heart transplantation. The authors note only one other report in the literature of prolonged Impella 5.5 support as bridge to heart transplantation and no reports in the existing literature of malfunctions or complications in patients with prolonged use (>50 days). Adding on to their discussion of the relevant literature, we wanted to note our published experience with a patient on prolonged Impella support beyond 50 days.2 The patient was a 51-year-old male with decompensated heart failure, chronic kidney disease, and cirrhosis who was sequentially supported with axillary intra-aortic balloon pump, Impella 5.5, and venoarterial extracorporeal membrane oxygenation (V-A ECMO) prior to triple organ, heart-liver-kidney transplantation. The patient was supported on Impella 5.5 for 79 days, comparable to the mean duration of support in the case series published by Zaky et al.1 Total length of temporary mechanical circulatory support (MCS) was 95 days prior to successful transplantation. During the period of Impella support in our patient, he had an episode of heparin-induced thrombocytopenia (HIT) at 30 days treated with argatroban and, subsequently, sepsis at 78 days, prompting Impella explant and initiation of V-A ECMO. Studies have evaluated the risk of these patterns of complications in patients supported with Impella and have shown an association between Impella support and HIT and sepsis.3–5 Our case report corroborates the findings of the reported case series.1 While our collective findings do demonstrate the efficacy of Impella 5.5 support for prolonged temporary MCS as a bridge to heart transplantation beyond the duration of less than or equal to 14 days as approved by the Food and Drug Administration, rates of complications during prolonged support have not been fully delineated. These potential complications do appear to be significant; however, they have not affected survival to transplantation based on our single-center experience. Multicenter, longitudinal studies are warranted to examine the risk and significance of complications of prolonged Impella support before prolonged use of this device becomes an established and widely applied bridging strategy.

Delayed-Onset Thalamic Dazzle and Homonymous Hemianopic Scotoma Following Bilateral Posterior Cerebral Artery Infarction.

Delayed-Onset Thalamic Dazzle and Homonymous Hemianopic Scotoma Following Bilateral Posterior Cerebral Artery Infarction.

Accuracy of Visual Fields in Localizing MRI Lesions in Posterior Cerebral Artery Infarction.

The representation of the visual field in visual cortex was established over a century ago by correlating perimetric defects with the estimated location of war wounds. The availability of high-definition MRI offers the possibility of more precise correlation. Homonymous hemianopias disclosed on automated visual fields (HVFs) were drawn from an electronic medical record search from 2009 to 2020 at the Michigan Medicine, a tertiary care academic medical center. The patterns of the visual field defects (VFDs) were interpreted by a consensus of 2 authors. The VFDs were correlated with the location of MRI lesions in 92 patients with posterior cerebral artery (PCA) domain ischemic strokes, as determined by the neuroradiologist author, who was masked as to the VFDs. Among the 77 VFDs confined to 1 hemifield, 74 (96%) correctly predicted the side of the visual cortex lesion. In 3 cases, the MRI lesion in the opposite cerebral hemisphere was not foretold. Among the 15 VFDs present in both hemifields, 5 (33.3%) overestimated the MRI lesions, which were evident in only 1 hemisphere. Among the 30 VFDs confined to 1 quadrant, 29 (97%) correctly predicted the lesioned visual cortex quadrant. However, 14 VFDs failed to predict MRI lesions present in both superior and inferior visual cortex quadrants on the same side. Those unpredicted lesions mostly had subtle or indistinct signal abnormalities or were confined to anterior visual cortex, an area that is inaccessible with the HVF test protocol used in this study. In this study of PCA ischemic stroke, VFDs limited to 1 hemifield were accurate in locating the side and quadrant of the MRI visual cortex lesions. However, the quadrantic VFDs sometimes failed to predict that the lesions involved both the superior and inferior quadrants on the same side, largely because those lesions had subtle imaging features that defied accurate radiologic assessment or were out of the reach of the visual field test protocol.

Correlation of Macular Sparing and Homonymous Paracentral Scotomas With MRI Lesions in Posterior Cerebral Artery Infarction.

The concepts of the representation of visual field in primary visual cortex are based on studies of war wounds and correlations with brain imaging in small cohorts. Because of the difficulty of judging brain lesion extent and the small number of studied patients, there is lingering controversy as to whether the central 15° of visual field are mapped onto the posterior 25% of primary visual cortex or onto a larger area. To improve the delineation of MRI lesion extent, we have studied only patients with posterior cerebral artery (PCA) ischemic strokes. We accrued a cohort of 92 patients with PCA strokes from an electronic medical records search between 2009 and 2020 at a single tertiary care academic institution. Patients had reliable static perimetry demonstrating homonymous hemianopias and high-definition reviewable brain imaging. We divided the primary visual cortex on the MRI T1 sagittal sequence into 8 equal segments in right and left cerebral hemispheres and located lesions according to the segments they occupied. We correlated lesion locations with 3 visual field defects (VFDs): macular-sparing homonymous quadrantanopias, macular-splitting homonymous quadrantanopias, and homonymous paracentral scotomas. Among 25 cases with macular sparing, 13 had lesion-sparing confined to the posterior 25% of visual cortex. Among 6 cases with homonymous paracentral scotomas, 2 had lesions confined to the posterior 25% of visual cortex. Macular-splitting quadrantanopia did not occur in any patients with lesions confined to the posterior 25% of visual cortex, but did occur in 3 patients with lesions confined to the posterior 50% of visual cortex. These phenomena would not be expected if the central 15° of visual field were mapped onto a region extending beyond the posterior 25% of visual cortex. In patients with PCA strokes that involved the retrogeniculate visual pathway proximal to visual cortex, the visual cortex lesions were often less extensive than predicted by the VFDs, perhaps because of widespread damage to axons before they reached their destination in visual cortex. These results support the concept that the central 15° of the visual field are represented in the posterior 25% of visual cortex. Although this study contributes a larger cohort of patients with better-defined lesion borders than in past reports, its conclusions must be tempered by the variability of patient attention during visual field testing, the subjectivity in the interpretation of the defect patterns, and the difficulty in judging MRI lesion extent even on diffusion-weighted and precontrast T1 sagittal sequences.

T2/FLAIR Hyperintensity in Mesial Temporal Lobe: Challenging Differential Diagnosis.

T2/FLAIR hyperintensity in the mesial temporal lobe is the most common MR finding of herpes simplex encephalitis, but may be observed in other infectious and non-infectious diseases. The former includes herpes human virus 6 encephalitis, Japanese encephalitis, and neurosyphilis, and the latter autoimmune encephalitis, gliomatosis cerebri, bilateral or paradoxical posterior cerebral artery infarction, status epilepticus, and hippocampal sclerosis. Thus, T2/FLAIR hyperintensity in the mesial temporal lobe is not a disease-specific magnetic resonance imaging finding, and these conditions must be differentiated to ensure proper treatment. We review diseases that present with T2/FLAIR hyperintensity in the mesial temporal lobe and provide a helpful flow chart based on clinical and radiologic features.

Predictors of morbidity and mortality during hospitalization following stroke.

Objective: The purpose behind this study was to determine the predictors of morbidity and mortality during hospitalization caused by cerebrovascular accident. Study Design: Cross Sectional study. Setting: Emergency Department of Medicine, Isra University Hospital, Hyderabad. Period: October 2017 to May 2018. Material &amp; Methods: We have evaluated a total of 124 patients who presented and were admitted with signs and symptoms of stroke and confirmatory diagnosis was made based on CT scan. All baseline and clinical variables recorded in a structured questionnaire and the data were evaluated in Statistical Package for the Social Sciences (SPSS) version 21.0. Outcome of these patients were observed based on the number of patients died during hospitalization and poor outcome associated predictors. Results: A total of 124 patients were selected for this study. The mean age of patients was 58.52 years (13.44 ± SD). In this observational study we have observed hypertension (N = 106, 85.5%) was the most common predictor of hospitalization among patients with stroke. The overall mortality associated with stroke was 16.13% (20 cases out of total 124). Infection of urinary tract during hospitalization, patients presented with unconsciousness, area of thalamic infarction, involvement of middle cerebral artery, and posterior cerebral artery infarction were the most common predictors of stroke related in-hospital mortality. Conclusion: Overall, corrected stroke related in-hospital mortality rate was 16.13% and patients who presented with loss of consciousness, infection of urinary tract, thalamic infarction, and area involving the middle cerebral artery were associated with higher in-hospital stroke related mortality.

Fetal-Type Variant of the Posterior Cerebral Artery and Concurrent Bilateral Cerebral Infarctions in a Korean Male Cadaver

Fetal-type variant of the posterior cerebral artery is a relatively common variant of the cerebral arterial circle (circle of Willis), but concurrent cerebral pathologies have not been well reported. We describe a case of fetal-type variant of the posterior cerebral artery and concurrent bilateral cerebral infarctions in the territories of the middle cerebral artery in a 78-year-old Korean male cadaver. Fetal-type variant of the posterior cerebral artery was found the right cerebral arterial circle, arose from the internal carotid artery with larger diameter than the pre-communicating segment from the basilar artery. Histopathological examination revealed that left supramarginal gyrus and right infraparietal lobule showed characteristic cerebral infarctions with chronological changes, respectively. Knowledge on the variation in the posterior cerebral artery combined with clinical features including cerebral infarction plays a pivotal role to anatomists and clinicians.

A clinical study of 288 patients with anterior cerebral artery infarction

Acute ischemic stroke in the territory of anterior cerebral artery (ACA) is uncommon. Therefore, large population studies evaluating ACA infarction are scarce. We sought to evaluate epidemiological and etiological characteristics of ACA infarction compared to other territorial infarctions. We analyzed a prospectively collected stroke registry of all acute ischemic stroke patients for 19years at two tertiary hospitals. We included patients with acute ischemic stroke caused by large vessel stenosis or occlusion including ACA, middle cerebral artery (MCA), posterior cerebral artery (PCA), and vertebrobasilar artery (VBA). A total of 4171 patients were enrolled. Patients with ACA infarction (N = 288) were significantly older with more females than those with MCA, PCA, or VBA infarction. There were more patients with history of prior ischemic stroke in the ACA infarction group than in other groups. The etiology of the ACA infarction was similar to those of the MCA, PCA and also the total population (66.7-71.8% of LAA and 17.9-20.9% of CE). When patients had prior ischemic stroke history, ACA infarction was more likely to be caused by LAA than MCA or PCA infarction (OR = 6.2, 95% CI 2.0-19.2, p = 0.002 and OR = 4.0, 95% CI 1.1-14.6, p = 0.038, respectively). Patients with ACA infarction had significantly more prior ischemic stroke than those with MCA, PCA, or VBA infarction. The etiology of ACA infarction in patients with prior ischemic stroke showed significantly more LAA than that of MCA or PCA infarction.

Post-stroke Visual Impairment Treated with Korean Medical Treatment: A Case Series

Objective: This study investigated two cases of Korean medical treatment for visual field impairment after stroke: Case 1, a 56-year-old male with a posterior cerebral artery infarction and right homonymous hemianopsia, and Case 2, a 46-year-old male with an intracerebral hemorrhage in the left parietal lobe and right homonymous hemianopsia.Methods: Case 1 was treated with acupuncture, electroacupuncture, and herbal medicine (&lt;i&gt;Mangeum-tang&lt;/i&gt;) for two months, and Case 2 was treated with acupuncture, electroacupuncture, and herbal medicine (&lt;i&gt;Oryeong-san&lt;/i&gt;) for 40 days.Results: Following treatment, for Case 1, the Humphrey visual field test showed improvement. The visual field indexes (VFIs) for the left and right eyes improved from 44% to 55% and 49% to 64% respectively, and the mean deviations (MDs) for the left and right eyes improved from -21.11 dB to -19.91 dB and -17.45 dB to -13.89 dB, respectively. The mean visual sensitivities (MVSs) of the left and right eyes also improved from 8.67 dB to 11.33 dB and 1.67 dB to 9.67 dB, respectively, with no side effects. For Case 2, the VFI for the left eye improved from 36% to 64% and that for the right eye remained unchanged. The MDs for the left and right eyes also improved from -22.02 dB to -14.47dB and -22.11 dB to -21.34 dB, respectively, with no side effects.Conclusions: This study suggests that Korean medical treatment may improve visual impairment after stroke, but further research is needed.

The Deception of Mass Effect: Subacute Posterior Cerebral Artery Infarction Presenting as a Mimic of Acute Middle Cerebral Artery Syndrome

Clinical data from 3 related cases sheds light on the complex presentation of subacute posterior cerebral artery strokes mimicking acute middle cerebral artery (MCA) syndrome. An expert witness in the field of interventional and diagnostic radiology defended a primary care physician against litigation for an alleged missed diagnosis using multimodality imaging to age a cerebrovascular event. The use of basic computerized tomography and magnetic resonance imaging physics principles are applied to determine whether a patient is outside the treatment window for thrombolytic administration or endovascular intervention. In the defended case, earlier stroke recognition would not have changed the patient’s outcome under question as he was deemed to have a completed infarct prior to presenting to the primary care physician’s (PCP’s) office, making the patient ineligible from acute stroke thrombolytic or endovascular treatment.

Acute occlusion of the fetal posterior cerebral artery: diagnosis and management paradigms.

The diagnosis and management of acute fetal posterior cerebral artery occlusion are challenging. While endovascular treatment is established for anterior circulation large vessel occlusion stroke, little is known about the course of acute fetal posterior cerebral artery occlusions. We report the clinical course, radiological findings and management considerations of acute fetal posterior cerebral artery occlusion stroke. We performed a retrospective review of consecutive patients presenting with acute large vessel occlusion who underwent cerebral angiogram and/or mechanical thrombectomy between January 2015 and January 2021. Patients diagnosed with fetal posterior cerebral artery occlusion were included. Demographic data, clinical presentation, imaging findings and management strategies were reviewed. Between January 2015 and January 2021, three patients with fetal posterior cerebral artery occlusion were identified from 400 patients who underwent angiogram and/or mechanical thrombectomy for acute stroke (0.75%). The first patient presented with concomitant fetal posterior cerebral artery and middle cerebral artery occlusions. Thrombectomy was performed with recanalisation of the fetal posterior cerebral artery but the patient died from malignant oedema. The second patient presented with isolated fetal posterior cerebral artery occlusion. No endovascular intervention was performed and the patient was disabled from malignant posterior cerebral artery infarct. The third patient presented with carotid occlusion and was found to have fetal posterior cerebral artery occlusion after internal carotid artery recanalisation. No further intervention was performed. The patient was left with residual contralateral homonymous hemianopia and mild left sided weakness. Fetal posterior cerebral artery occlusion is a rare, but potentially disabling, cause of ischaemic stroke. Endovascular treatment is feasible. Further investigation is needed to compare the efficacy of medical versus endovascular management strategies.

Intraoperative monitoring of somatosensory and visual evoked potentials for detecting posterior cerebral artery infarction during anteromesial temporal resection

Intraoperative monitoring of somatosensory and visual evoked potentials for detecting posterior cerebral artery infarction during anteromesial temporal resection

The anatomy of spatial neglect after posterior cerebral artery stroke.

Spatial neglect is a common consequence of stroke in the territory of the right middle cerebral artery. Damage to a perisylvian fronto-temporo-parietal network has been demonstrated to underlie this disorder. Less common, stroke to the posterior cerebral artery territory may also lead to spatial neglect. This study aimed to uncover the anatomical underpinnings of spatial neglect after posterior cerebral artery infarction. A sample of 50 posterior cerebral artery infarct patients was screened for spatial neglect. Neural correlates of neglect were investigated both with voxel-based lesion behaviour mapping and with region-of-interest analyses. Brain damage neither to the splenium, nor to the parahippocampal gyrus, nor to the thalamus was predictive of spatial neglect. Only damage to the perisylvian fronto-temporo-parietal network of spatial neglect was significantly associated with neglect severity. We conclude that both posterior and middle cerebral artery stroke induce spatial neglect after damage to the same perisylvian brain network. The findings contradict previous theories that postulated neural correlates of spatial neglect specifically supplied by the posterior cerebral artery. In posterior cerebral artery stroke patients, affected parts of this network are located at the border zone between the posterior and middle cerebral artery territories. Inter-individual variability in the localization of the border between both artery territories appears to mediate the occurrence of spatial neglect after posterior cerebral artery stroke.