Posterior Circulation Ischaemic Stroke

Abstract

Posterior circulation ischaemic stroke (PCIS) is a disease of high mortality and morbidity. They account for 20-25% of all ischaemic strokes. However, it is relatively under-researched and requires more clinical attention, since it carries worse functional outcomes. Vertigo, visual disturbances and sensory/motor disturbances are commonly observed in patients with PCIS. Large artery atherosclerosis and embolism are the main causes of PCIS, while there is growing evidence that vertebrobasilar dolichoectasia is a key associative factor. Hypertension is the most common risk factor, while diabetes mellitus is more specific to PCIS. PCIS is diagnosed through a range of neuroimaging techniques, which respectively examine structural brain abnormalities, vascular patency and perfusion. PCIS, in line with ischaemic stroke in general, necessitates medical treatment and lifestyle modifications. This includes smoking cessation, weight control, and alterations in dietary habits. Aspirin use also significantly improves survival outcomes. While intravascular and intra-arterial thrombolysis improve clinical outcomes, this is not proven conclusively for stenting and angioplasty. Future research on PCIS can focus on multi-centre epidemiological studies, clinically significant anatomical variants, and collateralisation.

Keywords: Cerebrovascular accidents; Ischaemic stroke; Neurology; Neuroradiology; Posterior circulation.