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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]
  • Meningioma presenting as stroke: report of two cases and estimation of incidence. J Neurol Neurosurg Psychiatry 2003;74:136-137. 4. Ko JK, Cha SH, Choi CH. Sphenoid ridge meningioma presenting as acute cerebral infarction.[j-stroke.org]
  • The most common presenting symptom of PCA dissection is occipital headache.[ruralneuropractice.com]
Pain
  • Completely new chapters discuss the increasing role of neurogenetics in the understanding and treatment of neurological disease, the importance of pain and its management and neurological complications associated with respiratory intensive care.[books.google.com]
  • Occlusions of the branches of the PCA that supply the thalamus can result in central post-stroke pain and lesions to the subthalamic branches can produce “a wide variety of deficits”. [1] Left posterior cerebral artery syndrome presents alexia without[en.wikipedia.org]
  • IPSILATERAL 1.Xth cranial nerve palsy 2.Cerebellar signs 3.Horner’s syndrome 4.Impaired pain, temperature and touch on the upper half of face B. CONTRA LATERAL 1.Impaired pain and temperature over the body 46.[slideshare.net]
  • Right hemispheric PCA infarctions may result in cause contralateral visual field neglect 2.Sensory findings in PCA infarct Some alteration of sensation are also observed in PCA infarct They are paresthesiae, or altered position, pain, and temperature[notes.medicosnotes.com]
  • . - Occlusion of the superior cerebellar artery results in severe ipsilateral cerebellar ataxia, nausea and vomiting, dysarthria, and contralateral loss of pain and temperature sensation over the extremities, body, and face (spino- and trigeminothalamic[medicowesome.com]
Physician
  • The third edition of this concise but comprehensive textbook follows on from the highly-regarded earlier editions in providing the trainee and general physician with a better understanding of the principles of neurology.[books.google.com]
Burning Pain
  • pain – Persistent, poor response to analgesics – Anticonvulsants (Carbamazepine, gabapentin) & TCAs used.[slideshare.net]
Overeating
  • Over a period of time, there will eventually develop ipsilateral or bilateral signs of infarct on MR or CT in the distribution of the posterior cerebral artery within the occipital lobe.[neuroradiologyonthenet.blogspot.com]
  • Anterior cerebral artery: Important to know: Occlusion of a single A2 segment of the ACA results in the contralateral symptoms such as: - Paralysis of opposite foot and leg due to involvement of the motor leg area - Cortical sensory loss over toes, foot[medicowesome.com]
  • CONTRA LATERAL 1.Impaired pain and temperature over the body 46.[slideshare.net]
  • 1 month), vomiting and drowsiness over the last 24 hours.[ruralneuropractice.com]
  • H-Hemorrhagic I-Ischemic T-TIA (Transient Ischemia Attack) T.I.A (Transient Ischemic attack) Patients often describe it as a shade being pulled over their eyes: S-H-A-D-E-D S-Sensory loss; TIA may herald a stroke H-Hypertension, Hyperlipidemia A-Amaurosis[valuemd.com]
Pulsatile Tinnitus
  • Case Presentation A 47-year-old homemaker woman with high blood pressure, which had been well controlled by medication, underwent magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) studies (Figure 1A) due to pulsatile tinnitus in[austinpublishinggroup.com]
Osteophyte
  • . • Fibromuscular dysplasia, dissection  common here • Rarely due to encroachment from osteophytic spurs within vertebral foramina LESIONS OF V2 & V3 43. • Subclavian occluded proximal to origin of vertebral. • Leads of reversal in the direction of blood[slideshare.net]
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]
Headache
  • Particular areas of enhanced coverage include headache, expanded beyond migraine to cover other presentations, and multiple sclerosis.[books.google.com]
  • Temporary homonymous hemianopsia may occur during the aura phase of a migraine headache.[healthline.com]
  • She felt chronic tension headache since then. Seven days after the first MR studies, she was found to be standing in stuporous state in the shower room.[austinpublishinggroup.com]
  • Unilateral headaches are the common presenting symptom making complicated migraine an important differential diagnosis.[ncbi.nlm.nih.gov]
  • Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalagia 1988;8(suppl 7):1–93.[karger.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]
Dysmetria
  • […] ophthalmoplegia One and a half syndrome Midbrain (CN 3, 4) Weber's syndrome ventral peduncle, PCA Benedikt syndrome ventral tegmentum, PCA Parinaud's syndrome dorsal, tumor Nothnagel's syndrome Claude's syndrome Other Alternating hemiplegia Cerebellum lateral ( Dysmetria[en.wikipedia.org]
  • . • 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]
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]
  • . • 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 nerve signs.[slideshare.net]
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]

Workup

  • Extensive cardiac workups, including Holter monitoring, and transthoracic and transesophageal echocardiography, did not reveal any intracardiac embolic source.[j-stroke.org]

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]
  • 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]
  • […] in long-term outcomes for both of these treatments.[patient.info]
  • 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]
  • 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]
  • 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]
  • 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]
  • 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]
  • 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 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]

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

  • 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]
  • In his case study, he emphasized a left occipital cortex lesion and also infarction of the splenium of the corpus callosum, which disconnected fibers from the right occipital lobe, preventing them from reaching the angular gyrus.[emedicine.medscape.com]

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