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Posterior Cerebral Artery Occlusion with Infarction

A Cerebri Posterior Occlusion with Infarction


Presentation

  • Particular areas of enhanced coverage include headache, expanded beyond migraine to cover other presentations, and multiple sclerosis.[books.google.com]
  • Apraxia of ocular movements is often present with bilateral lesions. Balints syndrome Some patients with bilateral occipital or parietooccipital infarctions present with Balints syndrome.[notes.medicosnotes.com]
  • The presentation in these patients varies from lethargic to obtunded to comatose, but some patients may be agitated and may have associated hemiplegia or hemisensory loss.[emedicine.medscape.com]
  • The most common presenting symptom of PCA dissection is occipital headache.[ruralneuropractice.com]
Anhidrosis
  • An ipsilateral Horner's syndrome (ptosis, miosis, anhidrosis) may be present. Inferior Cerebellar Infarction MRI Axial FLAIR Brain shows an infarct involving caudal portion of right cerebellar hemisphere.[neuroradiologycases.com]
Blurred Vision
  • Differential diagnosis Symptoms associated with vertebral artery occlusive disease include dizziness, vertigo, diplopia, perioral numbness, blurred vision, tinnitus, ataxia, bilateral sensory deficits, and syncope, all of which can be caused by other[patient.info]
Miosis
  • An ipsilateral Horner's syndrome (ptosis, miosis, anhidrosis) may be present. Inferior Cerebellar Infarction MRI Axial FLAIR Brain shows an infarct involving caudal portion of right cerebellar hemisphere.[neuroradiologycases.com]
Central Scotoma
  • scotoma): ( a ) Demyelination - multiple sclerosis, isolated optic neurities. ( b ) Ischemia of optic nerve. ( c ) Metabolic - vitamin B12 deficiency; alcoholic - nutritional amblyopia. 3, Transection of optic nerve(monocular blindness): ( a ) Tumor[dartmouth.edu]
Denial
  • This type of blindness is frequently associated with denial of visual loss (Anton syndrome), presumably a result of bilateral mesial temporal lobe ischemia-infarction.[dartmouth.edu]
  • The posterior watershed territory infarct between the MCA - PCA result in bilateral cortical visual abnormalities, among them cortical blindness, Anton's syndrome that is cortical blindness with denial/confabulation and Balint's syndrome that is asimultagnosia[neuroradiologycases.com]
Gerstmann Syndrome
  • syndrome (a combination of acalculia, finger agnosia, agraphia, and right/left confusion).[casemed.case.edu]
  • syndrome Astereognosis occipital lobe : Bálint's syndrome Cortical blindness Pure alexia temporal lobe : Cortical deafness Prosopagnosia Thalamus Thalamic syndrome Other Subclavian steal syndrome Upper motor neurone lesion ( Clasp-knife response ) Lower[en.wikipedia.org]
Dysesthesia
  • […] branches [4] visual agnosia [1] prosopagnosia [1] dyslexia, Anomic aphasia, color naming and discrimination problems [1] memory defect [1] topographic disorientation [1] Central Territory Lesions central post-stroke (thalamic) pain: spontaneous pain, dysesthesias[en.wikipedia.org]
Involuntary Movements
  • movements: chorea, intention tremor, hemiballismus [1] contralateral hemiplegia [1] Weber’s syndrome: occulomotor nerve palsy [5] Bálint's syndrome : loss of voluntary eye movements optic ataxia, asimultagnosia (inability to understand visual objects[en.wikipedia.org]
Thalamic Pain
  • ) pain: spontaneous pain, dysesthesias and sensory impairments [1] involuntary movements: chorea, intention tremor, hemiballismus [1] contralateral hemiplegia [1] Weber’s syndrome: occulomotor nerve palsy [5] Bálint's syndrome : loss of voluntary eye[en.wikipedia.org]
Astereognosis
  • […] tremor ) medial ( Cerebellar ataxia ) Basal ganglia Chorea Dystonia Parkinson's disease Cortex ACA syndrome MCA syndrome PCA syndrome frontal lobe : Expressive aphasia Aboulia parietal lobe : Receptive aphasia Hemispatial neglect Gerstmann syndrome Astereognosis[en.wikipedia.org]

Workup

  • Extensive cardiac workups, including Holter monitoring, and transthoracic and transesophageal echocardiography, did not reveal any intracardiac embolic source.[j-stroke.org]
  • The most important preventive treatments are appropriate range of motion and desensitization. [28] However, if these continue to become less tolerable and effective, further diagnostic workup, including triple-phase bone scanning, may be needed.[emedicine.medscape.com]
Central Scotoma
  • scotoma): ( a ) Demyelination - multiple sclerosis, isolated optic neurities. ( b ) Ischemia of optic nerve. ( c ) Metabolic - vitamin B12 deficiency; alcoholic - nutritional amblyopia. 3, Transection of optic nerve(monocular blindness): ( a ) Tumor[dartmouth.edu]

Treatment

  • Retaining an emphasis on the core clinical skills of history taking and careful neurological examination, the new edition has been thoroughly revised and updated to take into account new developments in investigation and treatment.[books.google.com]
  • Absolute contraindications to thrombolytic treatment: Onset of symptoms more than 4.5 hours ago before start of treatment or if time of stroke onset is unknown.[lecturio.com]
  • Endovascular treatment has been utilized as a modality of treatment of this rare entity [3]. But the proper choice of the treatment and the long term results are yet to be clear.[austinpublishinggroup.com]
  • Prompt treatment with thrombolytic drugs can restore blood flow and improve recovery from an infarct.[ncbi.nlm.nih.gov]
  • You can help by adding to it. ( March 2018 ) Treatment [ edit ] This section is empty.[en.wikipedia.org]

Prognosis

  • Rothrock J, North J, Madden K, Lyden P, Fleck P, Dittrich H: Migraine and migrainous stroke: Risk factors and prognosis. Neurology 1993;43:2473–2476. Zülch KJ: Über die Entstehung und Lokalisation der Hirninfarkte.[karger.com]
  • 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]
  • Although alertness generally returns, prognosis for good functional recovery is poor because of severe memory dysfunction. The syndrome may result from a “top of the basilar” artery embolus. The artery of Percheron may be involved.[emedicine.medscape.com]
  • 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]
  • Short-term prognosis of stroke due to occlusion of internal carotid artery based on transcranial Doppler ultrasonography. Stroke 1992 ;23: 1069 - 1072 13. Cavestri R, Radice L, Ferrarini F, et al.[nejm.org]

Etiology

  • ICD-10-CM Codes › I00-I99 Diseases of the circulatory system › I60-I69 Cerebrovascular diseases › Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology[icd10data.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 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]
  • Etiologies of Ischemic Posterior Circulation Stroke Beyond the minority of cases associated with vascular anomalies of the PC previously discussed, several pathological and demographic differences must be considered when determining stroke etiology.[frontiersin.org]

Epidemiology

  • Epidemiology/Etiology According to the World Health Organization (WHO), 15 million people suffer stroke worldwide each year.[physio-pedia.com]
  • Epidemiology A relatively uncommon form of stroke.[patient.info]
  • Third, CTA is reported to overestimate vascular stenosis compared with digital subtraction angiography; therefore, the epidemiological results of cerebrovascular changes should be treated with caution. 5 Conclusions Ipsilateral MCA, carotid artery, and[journals.lww.com]
  • […] from mild ischaemia to infarction If disabling symptoms still present when seen refer urgently for thrombolysis If symptoms resolved then refer urgently to TIA service Both TIA and small strokes have risk of large strokes so do all possible to prevent Epidemiology[medexam.net]
  • The extent of the cellular damage and neurologic deficit is determined by actual destruction of neural tissue. 3 Epidemiology Stoke is the third leading cause of death in the United States accounting for 1 out of every 15 deaths.[nursingcenter.com]
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]
  • To explain this, the following pathophysiological aspects should be considered: The irreversibly damaged cells form an infarct core.[lecturio.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]

Prevention

  • Even with vertebral artery occlusion, collaterals (circle of Willis) may prevent ischaemia.[patient.info]
  • Interventions are directed at preventing unplanned bowel movements, preventing constipation, and promoting efficient and effective bowel care.[emedicine.medscape.com]
  • Although we were confident with the patency of our bypass intraoperatively (and immediate postoperative angiography confirmed this), nevertheless we were thwarted in our goal of preventing a stroke.[asianjns.org]
  • Prevention of a stroke involves lifestyle changes as well as medication and surgery.[nursingcenter.com]
  • The majority of diagnostic procedures is aimed at long-term secondary prevention to prevent recurrent ischemic stroke. In addition to optimising cardiovascular risk factors, causative underlying diseases must be identified and treated.[lecturio.com]

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