In some early series, the diagnosis of vertebrobasilar disease was not confirmed by angiography or other vascular imaging. Past estimates of the frequency, sensitivity, and specificity of various clinical findings in patients suspected of having vertebrobasilar occlusive disease were not based on documentation of posterior circulation infarction. Separation of transient and persistent brain ischemia from other neurological causes as well as localization of the findings to the anterior or posterior circulation are based on symptoms and signs and are important to effectively plan brain and vascular imaging and other investigations. They provide the basis for clinical diagnosis. Symptoms and signs take center stage during the clinical encounter. Knowledge of the vascular territory involved aids in the diagnosis of the causative vascular lesion and stroke mechanism. Limb sensory deficit ( P = .001 95% CI, 1.8-7.8), lethargy ( P = .001 95% CI, 2.3-12.4), and visual field loss ( P = .001 95% CI, 5.3-23.9) were positively correlated with the distal territory.Ĭonclusions We report the most frequent symptoms and signs in the largest published registry, the New England Medical Center Posterior Circulation Registry, of patients with posterior circulation ischemia who had complete neurological examinations and extensive cerebrovascular imaging. Unilateral limb weakness ( P = .001 95% CI, 1.7-8.7) and cranial nerve VII deficits ( P = .02 95% CI, 1.1-5.3) were positively correlated with the middle territory. Logistic regression analysis reveals that the clinical features dysphagia ( P = .004 95% CI, 1.8-24.4), nausea or vomiting ( P = .002 95% CI, 1.6-8.2), dizziness ( P = .047 95% CI, 1.0-5.4), and Horner syndrome ( P = .001 95% CI, 2.4-26.6) were positively correlated with the proximal vascular territory. The most frequent signs were unilateral limb weakness (38%), gait ataxia (31%), unilateral limb ataxia (30%), dysarthria (28%), and nystagmus (24%). Results The most frequent posterior circulation symptoms were dizziness (47%), unilateral limb weakness (41%), dysarthria (31%), headache (28%), and nausea or vomiting (27%). Correlations between symptoms and signs with separate vascular territories of the posterior circulation were then analyzed. These outcome measures were planned before data collection began. Main Outcome Measures Frequencies of posterior circulation ischemic symptoms and signs. All patients had either computed tomography or magnetic resonance imaging of the brain as well as vascular imaging of the head and neck. All patients were examined by senior stroke neurologists. Patients Consecutive sample of 407 adult patients who had stroke and/or transient ischemic attacks in the posterior circulation within 6 months of study inclusion. Setting Outpatient and inpatient setting at the New England Medical Center, a tertiary care referral center in Boston, Massachusetts.
#Pica artery series#
Objective To evaluate the frequencies of symptoms and signs in patients with posterior circulation ischemia in a large case series of prospectively collected patients. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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