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Posterior Cerebral Artery Occlusion


Presentation

  • Visual hallucinations were the presenting symptoms in 2 patients with probable infarcts in the territory of a posterior cerebral artery. They occurred in areas of paracentral scotomas, right in Patient 1 and left in Patient 2.[ncbi.nlm.nih.gov]
  • Abstract Following a head injury, a 14-month-old male presented with neck stiffness and 24 hours later developed bilateral lateral rectus palsies.[ncbi.nlm.nih.gov]
  • METHODS: The authors present a technical report of a successful thromboembolectomy in the proximal posterior cerebral artery.[ncbi.nlm.nih.gov]
  • Eight patients presented with visual field defects and variable additional symptoms. One patient suffered bithalamic infarction. Median time to treatment was 5.8 h.[ncbi.nlm.nih.gov]
  • The most common presenting symptom of PCA dissection is occipital headache.[ruralneuropractice.com]
Venous Insufficiency
  • Aortic arch syndrome (Medical Encyclopedia) Arterial embolism (Medical Encyclopedia) Arteriogram (Medical Encyclopedia) Cerebral angiography (Medical Encyclopedia) Duplex ultrasound (Medical Encyclopedia) Venous insufficiency (Medical Encyclopedia) Venous[icdlist.com]
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]
  • She demonstrated a right homonymous hemianopsia but other cranial nerves were normal as was her muscular strength and sensory systems.[lksom.temple.edu]
  • 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]
  • […] neoplams, most often chromphobe adenoma with suprasellar extension or suprasellar neoplasm such as craniopharyngioma. ( b ) Hydrocephalus with ballooning of floor of third ventricle. 6, Optic tract or lateral geniculate loss (contralateral homonymous hemianopsia[dartmouth.edu]
  • Infarctions in the territory of the PCA most often result in a contralateral hemianopsia. Other signs and symptoms depend on whether the infarction involves the thalamoperforator territory, and whether the infarction is left vs. right sided.[casemed.case.edu]
Scotoma
  • They occurred in areas of paracentral scotomas, right in Patient 1 and left in Patient 2. In Patient 1 they were formed, prolonged, and not apparently related to past experience.[ncbi.nlm.nih.gov]
  • […] the arterial compression of severe papilledema. ( b ) Inflammatory - choroiditis, granuloma; neoplastic - primary or metastatic; mechanical - retinal tear or detachment. ( c ) Glaucoma - frequent selective nerve fiber bundle loss causing a crescent scotoma[dartmouth.edu]
Lacrimation
  • The lacrimal artery runs parallel to the lacrimal branch of V 1 in the superior lateral orbital roof to reach the lacrimal gland.[aao.org]
Suggestibility
  • Arteriograms showed distal filling of the occluded PCA, but no collateral blood flow from the carotid circulation, suggesting collateral flow from leptomeningeal anastomoses.[ncbi.nlm.nih.gov]
  • The distribution of low-density areas on computed tomography (CT) suggested occlusions in the proximal half of the circummesencephalic portion in 38 patients with posterior cerebral artery (PCA) occlusion.[ncbi.nlm.nih.gov]
  • Annals of Biomedical Engineering. 2013; 41(7): 1366-1383 4 Suggested Connections Between Risk Factors of Intracranial Aneurysms: A Review Juan R.[neurologyindia.com]
  • Extra notes: - A combination of sensory disturbance, motor weakness, and nonfluent aphasia suggests that an embolus has occluded the proximal superior division. - If a fluent (Wernicke’s) aphasia occurs without weakness, the inferior division of the MCA[medicowesome.com]
Visual Hallucination
  • Visual hallucinations were the presenting symptoms in 2 patients with probable infarcts in the territory of a posterior cerebral artery. They occurred in areas of paracentral scotomas, right in Patient 1 and left in Patient 2.[ncbi.nlm.nih.gov]
  • hallucinations visual and color agnosias Prosopagnosia.[notes.medicosnotes.com]
  • Unformed visual hallucinations, peduncular hallucinosis, metamorphopsia, teleopsia, illusory visual spread, palinopsia, distortion of outlines, central photophobia: Calcarine cortex. Complex hallucinations: Usually nondominant hemisphere.[fmritools.com]
  • Extra notes: - Occlusion of the posterior cerebral artery can produce peduncular hallucinosis (visual hallucinations of brightly colored scenes and objects). - Bilateral infarction in the distal PCAs produces cortical blindness (blindness with preserved[medicowesome.com]
Neglect
  • Associated clinical signs were aphasia, alexia or a neglect syndrome, hemianopia, and hemisensory loss. Hemiplegia was due to infarction in the lateral midbrain.[ncbi.nlm.nih.gov]
  • The majority of patients developed contralateral hemiparesis, homonymous hemianopia, hemispatial neglect, and sensory loss or sensory inattention. All 8 patients with dominant hemisphere lesions were aphasic.[ncbi.nlm.nih.gov]
  • Some patient with Proximal PCA occlusion may simulate MCA occlusion when it result in Hemiparesis Hemianopsia Hemispatial neglect Aphasia Sensory inattention. Cortical signs are probably explained by thalamic involvement[notes.medicosnotes.com]
  • Neglect is most often associated with right-hemisphere strokes, so expect a patient with left-sided weakness to have neglect as well—and stay especially alert for this sign.[americannursetoday.com]
Neck Stiffness
  • Abstract Following a head injury, a 14-month-old male presented with neck stiffness and 24 hours later developed bilateral lateral rectus palsies.[ncbi.nlm.nih.gov]
  • . • D/D: Viral labrynthitis (Headache, neck stiffness & unilateral dysmetria favor stroke) CEREBELLAR INFARCTION 48. THANK YOU Dr.Karthik Raghavan Postgraduate MD (Int. Med) SRM Medical College & Hospital[slideshare.net]
Hemianesthesia
  • Middle cerebral artery: Important to know: - If the entire MCA is occluded at its origin, the clinical findings are contralateral hemiplegia, hemianesthesia and homonymous hemianopia.[medicowesome.com]

Workup

Mural Thrombus
  • A second scan performed 96 hours after the head injury revealed a mural thrombus at the tip of the basilar artery without any evidence of infarction. A third scan performed 12 days later revealed that the thrombus had resolved.[ncbi.nlm.nih.gov]

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]
  • CONCLUSION: IAT is a feasible treatment of isolated PCA strokes. Clinical outcome was favorable in the majority of patients after IAT and IVT. No major complications were observed.[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]
  • 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]
  • Other treatments include medicines and surgery.[icdlist.com]

Prognosis

  • Recognition of this syndrome has implications for management and prognosis.[ncbi.nlm.nih.gov]
  • 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]
  • As shown here, newer generation stent-retrievers can also achieve rapid and complete arterial recanalisation of distal thrombus in the posterior circulation preventing an increase in the ischaemic volume, which appears to directly affect the clinical prognosis[ejmint.org]
  • Prognosis This will depend on the extent of disease; however: Acute basilar artery occlusion has a very high mortality rate. Vertebrobasilar stroke usually leaves significant neurological deficits.[patient.info]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • 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]
  • In this case, due to the configuration and distal location of the aneurysm in the posterior circulation, it was probable that dissection was the etiology.[ruralneuropractice.com]
  • In spite of thorough diagnostic evaluation, the etiology of PCA territory infarction cannot be determined in at least one quarter of patients.[ncbi.nlm.nih.gov]
  • 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

Sex distribution
Age distribution

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]
  • ., In Barnett HJM at al (eds) Stroke Pathophysiology, Diagnosis, and Management New York Churchill Livingstone 1992 125]. The posterior arteries supply the temporal and occipital lobes of the left cerebral hemisphere and the right hemisphere.[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]
  • In: Barnett HJ, Mohr JP, Stein B, Yatsu F (eds) Stroke: pathophysiology, diagnosis and management. Livingstone, New York, pp 451–474 Google Scholar 43. Nissl von Mayendorf E (1911) Die aphasischen Symptome und ihre corticale Lokalisation.[link.springer.com]
  • Pathophysiology Atherosclerosis : the most common vascular disease affecting the vertebrobasilar system: [ 1 ] This affects large vessels, causing narrowing and occlusion.[patient.info]

Prevention

  • 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]
  • Even with vertebral artery occlusion, collaterals (circle of Willis) may prevent ischaemia.[patient.info]
  • Hence, proactive treatments are given to prevent rebleeding. Posterior cerebral artery (PCA) aneurysms are quite rare, comprising approximately 1% of all intracerebral aneurysms [1]. Dissecting aneurysms account for about 35% of PCA aneurysms [2].[austinpublishinggroup.com]
  • As shown here, newer generation stent-retrievers can also achieve rapid and complete arterial recanalisation of distal thrombus in the posterior circulation preventing an increase in the ischaemic volume, which appears to directly affect the clinical[ejmint.org]

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