Presentation
This case presents a departure from the presentation of a traditional posterior circulation cerebral infarction most likely as a result of a rare vascular anomaly rooted in an aberrant embryological process. [karger.com]
The most common presenting symptom of PCA dissection is occipital headache. [ruralneuropractice.com]
A case of bilateral PCA infarct presenting with marked behavioral symptoms and minimal neurological symptoms is presented here. [ijpm.info]
Amnesia is usually said to require bilateral lesions but four cases in the present series appeared to have unilateral (left‐sided) occlusion. [onlinelibrary.wiley.com]
Each patient presented with subarachnoid hemorrhage (SAH), and some of them also presented with intraventricular hemorrhage (IVH) (n = 4) or intracerebral hematoma (ICH) (n = 2). [thejns.org]
Respiratoric
- Hypophonia
Acute bilateral thalamic infarction as a cause of acute dementia and hypophonia after occlusion of the artery of Percheron. J Neurol Sci, 283 (2009), pp. 175-177 [4] S.E. Bain, D.T. Hsieh, L.G. Vezina, T. Chang. [elsevier.es]
Eyes
- Hemianopsia
Abstract The authors report a case of isolated homonymous hemianopsia secondary to embolic occlusion of the posterior cerebral artery. The cause of embolism was demonstrated to be spondylitic vertebral artery compression. [ncbi.nlm.nih.gov]
Right PCA Left homonymous hemianopsia due to damage to right visual cortex in the occipital lobe. [neuroanatomy.ca]
Whereas a pituitary tumor compressing the optic chiasm results in bilateral temporal heteronymous hemianopsia (where heteronymous means in two different visual fields). [forums.studentdoctor.net]
Conclusion: Korean medicine treatment can be considered an effective treatment for homonymous hemianopsia in stroke patients. Keywords case report;homonymous hemianopsia;Bojungikki-tang;visual field test;visual defect [koreascience.or.kr]
She demonstrated a right homonymous hemianopsia but other cranial nerves were normal as was her muscular strength and sensory systems. [lksom.temple.edu]
- Vertical Gaze Palsy
Coma with vertical gaze palsy: relevance of angio-CT in acute Percheron artery syndrome. Case Rep Neurol, 2 (2010), pp. 74-79 [7] L. Rivera-Lara, N. Henninger. Delayed sudden coma due to artery of Percheron infarction. [elsevier.es]
Vertical gaze palsy and horizontal gaze weakness are both clinical signs exhibited by this patient that indicate that he experienced rostral brainstem infarction [1, 5]. [karger.com]
These can result in: Ipsilateral lateral gaze palsy. Conjugate gaze palsy. Ocular bobbing. Midbrain syndromes: Vertical gaze palsy. Third cranial nerve palsy. Pontine syndromes: Tremor, ataxia and mild hemiparesis. Horizontal gaze palsy. [patient.info]
Neurologic
- Micropsia
Palinopsia, micropsia, and macropsia These are illusory phenomena that are of uncertain pathophysiology. Palinopsia describes the persistence of a visual image for several seconds to days in a partially blind hemifield. [emedicine.medscape.com]
- Long Tract Signs
Extra notes: - Complete basilar occlusion causes bilateral long tract signs (sensory and motor) with signs of cranial nerve and cerebellar dysfunction. [medicowesome.com]
Structures supplied by BASILAR 30. • Complete basilar occlusion – Constellation of bilateral long tract signs (sensory & motor) with signs of cranial nerve & cerebellar dysfunction. • “Locked-in” state: – Preserved consciousness with quadriplegia & cranial [slideshare.net]
- Rubral Tremor
Contralateral rhythmic, ataxic action tremor; rhythmic postural or "holding" tremor (rubral tremor): Dentatothalamic tract. [fmritools.com]
Contralateral rhythmic, ataxic action tremor; rhythmic postural or "holding" tremor (rubral tremor): Dentatothalamic tract. See also[edit] Circle of Willis Anterior cerebral artery Additional images[edit] Arteriogram of the arterial supply. [en.wikipedia.org]
- Slow Speech
Stroke affecting the posterior cerebral artery may also affect the brainstem or cerebellum resulting in slurred and slow speech. [newhealthadvisor.com]
- Lower Motor Neurone Lesion
neurone lesion (Clasp-knife response) Lower motor neurone lesion [en.wikipedia.org]
Workup
Conclusion The symptomatology of the patient did not align with all of the deficits that usually present with an infarction of the posterior circulation, and the radiological workup revealed an fPCA on the right side. [karger.com]
Additional tests can be ordered such as ANA with titers, ESR, CRP, ANCA for vasculitis, hypercoagulable panel for coagulopathy, and genetics tests for an unknown cause of stroke after the first workup. [ncbi.nlm.nih.gov]
EEG
- Epileptiform Activity
An ictal contribution to the depressed sensorium was confirmed when electroencephalography showed intermittent epileptiform activity in the left temporal region. [journals.sagepub.com]
Treatment
Endovascular treatment techniques provide additional treatment options. In selected cases, high revascularization rates following microsurgical thromboembolectomy in the anterior circulation were reported. [ncbi.nlm.nih.gov]
Endovascular treatment techniques provide additional treatment options. In selected cases, high revascularization rates following microsurgical thrombembolectomy in the anterior circulation were reported. [neurosurgerycns.wordpress.com]
The benefit of mechanical thrombectomy (MT) compared to IV thrombolysis (tPA) for the treatment of an acute posterior cerebral artery (PCA) occlusion is uncertain. [journals.heart.org]
No neurologic deficit occurred after treatment. Clinical presentations and grades were typical. [ajnr.org]
Endovascular treatment of posterior cerebral artery aneurysms. AJNR Am J Neuroradiol 2006;27:300-5. 8. Honda M, Tsutsumi K, Yokoyama H, Yonekura M, Nagata I. Aneurysms of the posterior cerebral artery; Retrospective review of surgical treatment. [ruralneuropractice.com]
Prognosis
Recognition of this syndrome has implications for management and prognosis. [ncbi.nlm.nih.gov]
Keywords : Stroke; Carotid artery internal; Posterior cerebral artery; Anterior choroidal artery; Anatomy; Prognosis. [scielo.org.co]
Conclusion : Carotid artery invasion by malignancy portends a poor prognosis. Carotid artery resection can provide reasonable palliation. The head and neck surgeon faces a d i fficult dilemma because of its high mortality and neurologic morbidity. [dbpia.co.kr]
Links: anatomy risk factors pathogenesis clinical features investigations management prognosis General Practice Notebook General Practice Notebook The information provided herein should not be used for diagnosis or treatment of any medical condition. [gpnotebook.co.uk]
Keywords: Stent-assisted coil embolization; Hemorrhagic P1 dissection; Posterior cerebral artery Introduction Hemorrhagic dissecting aneurysms of cerebral artery tend to rebleed and the prognosis after rebleeding is poor. [austinpublishinggroup.com]
Etiology
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
Etiologies: Most often embolic from heart, aorta or the internal carotid artery. Rarely, due to intrinsic atherosclerotic disease of the ACA. [casemed.case.edu]
The clinical evidence for herniation itself includes an ipsilateral dilated pupil and contralateral hemiparesis, though these may be difficult to discern in the setting of already increased intracranial pressure due to the underlying etiology. [neuroradiologyonthenet.blogspot.com]
We presented a patient with a posterior cerebral artery territory infarction due to an unexpected etiology as stenosis of internal carotid artery (ICA) with existence of fetal type PCA. 1. [hindawi.com]
The suddenness of the loss suggests a vascular etiology and the symptoms are referable to branches of the posterior cerebral artery. [lksom.temple.edu]
Epidemiology
Epidemiology A relatively uncommon form of stroke. However: Stroke is the fourth[2]biggest cause of death in the UK. 25% of lesions causing stroke occur in the vertebrobasilar circulation[1]. [patient.info]
General epidemiological characteristics and clinical presentation are reported in Table 1. Table 1. Characteristics of stroke and stroke mimic population. [scielo.br]
However, there are no epidemiological P2 segment and distal aneurysm data so far. The literature regarding the therapy of P2 segment and distal aneurysms are extremely limited to small case series and case reports. [thejns.org]
Vertebrobasilar Dolichoectasia (VBD) is another occasional cause of PCA stroke. [11] Epidemiology Stroke, a leading cause of adult disability, [12] is the fifth leading cause of death in the United States. [ncbi.nlm.nih.gov]
Pathophysiology
(eds) Mohr JP, Choi DW, Grotta JC, et al: Stroke: Pathophysiology, Diagnosis and Managemen 4 Philadelphia, Churchill Livingstone, 2004;167-192 Caplan LR, Bogousslavsky J: Posterior cerebral artery syndromes. [karger.com]
[…] of moyamoya disease: an update J Stroke 2016 18 12 20 4 Najm IM Tilelli CQ Oghlakian R Pathophysiological mechanisms of focal cortical dysplasia: a critical review of human tissue studies and animal models Epilepsia 2007 48 Suppl 2 21 32 5 Abe T Singer [j-nn.org]
Posterior Cerebral Artery The posterior cerebral arteries stem in most individuals from the basilar artery but sometimes originate from the ipsilateral internal carotid artery [Garcia JH et al., In Barnett HJM at al (eds) Stroke Pathophysiology, Diagnosis [strokecenter.org]
Palinopsia, micropsia, and macropsia These are illusory phenomena that are of uncertain pathophysiology. Palinopsia describes the persistence of a visual image for several seconds to days in a partially blind hemifield. [emedicine.medscape.com]
Prevention
[…] to Prevent and Treat Stroke Complications ); these measures clearly improve clinical outcomes ( 1 ). [merckmanuals.com]
See also the separate Stroke Prevention article. [patient.info]
Blood thinners such as aspirin or clopidogrel can help prevent a clot from forming in the artery. Statins can help prevent the continued build up of cholesterol plaque in the artery. [cedars-sinai.edu]
Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients. [books.google.es]
This experience, although limited, suggests that to prevent unexpected complications as in this case, it needs more attentive involvement of neurologists as a consultant.Korean Journal of Stroke 1999;1(1):91~94 [dbpia.co.kr]