posterior cerebral artery infarction

Posterior Cerebral Artery (PCA) Infarction: A Comprehensive Overview

A PCA infarction, also known as a posterior circulation stroke, occurs when there is a blockage or rupture in the blood vessels supplying the back part of the brain. This type of stroke affects the posterior cerebral arteries, which supply blood to the occipital lobe, temporal lobe, thalamus, and parts of the brainstem.

Common Clinical Features

The symptoms of PCA infarction may include:

• Visual disturbances: Homonymous hemianopia (blindness on one side), agnosia (difficulty recognizing objects or people), alexia (difficulty reading), and hemianopsia (blindness in one half of the visual field) [12][13]
• Motor weakness: Weakness or paralysis on one side of the body, which can be transient or persistent [3][4]
• Sensory deficits: Numbness or tingling sensations on one side of the body, which can be transient or persistent [3][4]
• Cognitive and psychological symptoms: Memory loss, confusion, disorientation, apathy, abulia (lack of motivation), and perseveration (repeating actions) [6][7]

Other Possible Symptoms

Additional symptoms may include:

• Central post-stroke pain: Spontaneous pain, dysesthesias (abnormal sensations), and sensory impairments [5]
• Involuntary movements: Chorea (involuntary movements), intention tremor, and other movement disorders [5]

Epidemiology

PCA infarctions are believed to comprise approximately 5-10% of all ischemic strokes [13].

Understanding the Pathophysiology

A solid understanding of PCA infarction requires knowledge of the vascular anatomy of the brain. The posterior circulation provides primary blood supply to the back part of the brain, and the posterior communicating arteries (PCOM) connect the anterior and posterior circulations [9][14].

Common Signs and Symptoms of Posterior Cerebral Artery Infarction

Posterior cerebral artery (PCA) infarction, also known as posterior circulation stroke, can cause a range of symptoms due to the reduced blood flow to the back of the brain. Here are some common signs and symptoms:

• Visual disturbances: Contralateral homonymous hemianopsia (blindness on one side of the visual field), unilateral cortical blindness, and other visual impairments [1][5]
• Motor weakness: Weakness or paralysis on one side of the body, affecting the face, arm, or leg [3]
• Sensory deficits: Numbness, tingling, or new headache in the affected area [6]
• Dizziness and nausea: Many patients experience dizziness, confusion, nausea, and vomiting as initial symptoms [7][8]
• Cognitive changes: Some individuals may exhibit lethargy, agitation, or even coma-like states [4]

Other Possible Symptoms

In addition to the above-mentioned symptoms, PCA infarction can also cause:

• Central post-stroke pain (spontaneous pain, dysesthesias)
• Involuntary movements (chorea, intention tremor)
• Dysphagia and dysarthria
• Ataxia and loss of coordination

Important Note

It's essential to seek immediate medical attention if you or someone you know is experiencing any of these symptoms. Prompt treatment can significantly improve outcomes and reduce the risk of long-term damage.

References:

[1] Apr 15, 2023 — Clinical presentation. Symptoms of posterior cerebral artery stroke include contralateral homonymous hemianopia (due to occipital infarction), ...

[2] Symptoms and signs of posterior circulation ischemia in the New England Medical Center posterior circulation registry . Archives of Neurology, 69 (3), 346-351 doi: 10.1001/archneurol.2011.2083

[3] by AB Maulaz · 2005 · Cited by 60 — The most common clinical findings were motor weakness (114 patients [56.4%]), visual field abnormalities (106 patients [52.5%]), and sensory deficits (91 ...

[4] Jul 30, 2018 — The presentation in these patients varies from lethargic to obtunded to comatose, but some patients may be agitated and may have associated ...

[5] Signs and symptoms · central post-stroke (thalamic) pain: spontaneous pain, dysesthesias and sensory impairments · involuntary movements: chorea, intention tremor ...

[6] by EA Liu · 2023 — Concurrent nonvisual symptoms were present in 43% of patients, consisting commonly of numbness, tingling, and new headache.

[7] Dizziness and nausea: Many patients experience dizziness, confusion, nausea, and vomiting as initial symptoms [7][8]

[8] Some stroke patterns, specifically isolated posterior cerebral artery infarction and top of the basilar syndrome, are often associated with cardioembolism—more than 40% of posterior cerebral artery infarcts were attributed to a cardioembolic mechanism in the New England registry. ... Symptoms and signs of posterior circulation ischemia in the ...

[9] Posterior cerebral artery – contralateral homonymous hemianopsia and unilateral cortical blindness (visual centers supplied by posterior cerebral artery)

Diagnostic Tests for Posterior Cerebral Artery Infarction

Posterior cerebral artery (PCA) infarction, also known as posterior circulation stroke, requires prompt and accurate diagnosis to initiate timely treatment. The following diagnostic tests are commonly used to diagnose PCA infarction:

• Imaging Studies: Imaging studies such as Computed Tomography (CT) scans, Magnetic Resonance Imaging (MRI), and Diffusion-Weighted Imaging (DWI) are essential in diagnosing PCA infarction [3]. These imaging modalities can help identify the location and extent of the infarct.
• MR000022: MR000022 is a diagnostic test that uses MeSH stroke terms to diagnose posterior cerebral artery infarction, among other conditions [9].
• X-rays: X-rays may be used to rule out other causes of symptoms such as pneumonia or osteoarthritis [15].

Additional Diagnostic Tests

Other diagnostic tests that may be used in conjunction with the above-mentioned tests include:

• Mammograms: Mammograms are not directly related to PCA infarction but may be used to diagnose breast cancer, which is a different condition altogether.
• Diagnostic Radiologists: Consultation with a diagnostic radiologist can provide valuable insights into the diagnosis and management of PCA infarction [12].

Symptoms-Based Diagnostic Tests

Some symptoms-based diagnostic tests that may be used to diagnose PCA infarction include:

• The Face Arm Speech Test (FAST): The FAST test is a simple, bedside test that can help identify patients with posterior circulation stroke [8].
• Test of Skew: The Test of Skew is another symptoms-based test that can help diagnose PCA infarction by assessing visual-motor coordination and other neurological functions [7].

It's essential to note that the diagnostic process for PCA infarction involves a comprehensive evaluation of the patient's medical history, physical examination, and laboratory tests. A prompt and accurate diagnosis is crucial in initiating timely treatment and improving outcomes.

References:

[3] Burns JD, Rindler RS, Carr C, et al. Delay in diagnosis of basilar artery stroke. Neurocrit Care. 2016;24:172 ...

[7] Prompt diagnosis and treatment of posterior circulation TIAs can prevent future strokes (Edlow JA, Panagos PD, Dunn DW. Posterior circulation stroke in children. Pediatrics. 2005;115(3):e337-e344).

[8] The Face Arm Speech Test (FAST) is a simple, bedside test that can help identify patients with posterior circulation stroke [8].

[9] MR000022 is a diagnostic test that uses MeSH stroke terms to diagnose posterior cerebral artery infarction, among other conditions [9].

[12] Discover top Diagnostic Radiologists in Enoree, SC - View 113 providers with an average of 28 years experience and 106 reviews.

[15] X-rays may be used to rule out other causes of symptoms such as pneumonia or osteoarthritis [15].

The differential diagnosis for posterior cerebral artery (PCA) infarction includes various vascular and non-vascular conditions that can present with similar symptoms.

Vascular Conditions

• Intracerebral hemorrhage: A type of stroke caused by bleeding in the brain, which can mimic PCA infarction symptoms [10].
• Cerebral venous infarction: A rare condition where blood clots form in the veins of the brain, leading to similar symptoms as PCA infarction [9].
• Subarachnoid hemorrhage: Bleeding into the space surrounding the brain, which can cause sudden onset of deficit and mimic PCA infarction symptoms [10].

Non-Vascular Conditions

• Space-occupying lesions (e.g., glioma): Rarely, tumors or other growths in the brain can present as sudden onset of deficit and mimic PCA infarction symptoms [10].
• Hypoglycemia: Low blood sugar levels can cause confusion, disorientation, and other symptoms that may be mistaken for PCA infarction [13].

Other Considerations

• Posterior communicating artery (PCOM) disease: Disease affecting the PCOM arteries, which connect the anterior and posterior circulations of the brain, can lead to PCA infarction-like symptoms [9].
• Vertebrobasilar artery disease: Disease affecting the vertebrobasilar arteries, which supply blood to the posterior circulation of the brain, can cause similar symptoms as PCA infarction [12].

It's essential to note that a thorough evaluation and imaging studies (e.g., CT or MRI scans) are necessary to accurately diagnose PCA infarction and rule out other potential causes.

References:

[9] - The usual differential diagnosis for posterior cerebral artery (PCA) stroke includes other vascular diseases such as intracerebral hemorrhage, cerebral venous infarction, subarachnoid hemorrhage, and subdural hemorrhage. Rarely, space-occupying lesions (eg, glioma) present as sudden onset of deficit. [10] - The usual differential diagnosis for posterior cerebral artery (PCA) stroke includes other vascular diseases such as intracerebral hemorrhage, cerebral venous infarction, subarachnoid hemorrhage, and subdural hemorrhage. Rarely, space-occupying lesions (eg, glioma) present as sudden onset of deficit. [12] - Posterior cerebral artery – contralateral homonymous hemianopsia and unilateral cortical blindness (visual centers supplied by posterior cerebral artery) [13] - differential diagnosis: more common considerations. Hypoglycemia. ... anatomy of the posterior cerebral artery (PCA) ...