Advertisement

Neurological Sciences

, Volume 40, Issue 10, pp 1995–2006 | Cite as

Posterior circulation ischaemic stroke—a review part I: anatomy, aetiology and clinical presentations

  • Marco SparacoEmail author
  • Ludovico Ciolli
  • Andrea Zini
Review Article

Abstract

Posterior circulation ischaemia is a clinicopathological condition with complex symptomatology associated with an infarction within the vertebrobasilar arterial system. Posterior circulation strokes account for about 20–25% of all ischemic strokes and remain a significant cause of patient disability and mortality. Diagnosis can be challenging because presenting symptoms are often non-focal and because there is a substantial overlap in symptoms and signs of ischaemia in the anterior circulation. Despite better imaging techniques, diagnosis and treatment of life-threatening conditions, such as basilar artery occlusions, are often delayed. Therefore, early detection of symptoms and causes of posterior circulation ischaemia is essential for choosing the most appropriate therapy. In this review, we summarise the anatomy, aetiology, typical presentations and characteristic findings of common strokes resulting from disease in the vertebrobasilar arterial system.

Keywords

Vertebrobasilar arterial system Posterior cerebral ischaemia Basilar artery occlusion 

Notes

Author contributions

Dr. Sparaco: study design, manuscript drafting/revising, study supervision.

Dr. Ciolli, Dr. Zini: manuscript drafting/revising.

Compliance with ethical standards

Conflict of interest

Marco Sparaco reports no disclosures.

Ludovico Ciolli reports no disclosures.

Andrea Zini reports received consultancy and speaker fees from Boehringer-Ingelheim, Medtronic, Stryker and Daiichi Sankyo.

We performed a review of the literature about the state of art of vertebrobasilar stroke; therefore, our work did not involve neither human participants nor experiments on animals.

References

  1. 1.
    Bogousslavsky J, Van Melle G, Regli F (1988) The Lausanne stroke registry: analysis of 1000 consecutive patients with first stroke. Stroke 19:1083–1092CrossRefGoogle Scholar
  2. 2.
    Flossmann E, Rothwell PM (2003) Prognosis of vertebrobasilar transient ischaemic attack and minor stroke. Brain 126:1940–1954.  https://doi.org/10.1093/brain/awg197 CrossRefGoogle Scholar
  3. 3.
    Dewey HM, Sturm J, Donnan GA, Macdonell RAL, McNeil JJ, Thrift AG, North East Melbourne Stroke Incidence Study (2003) Incidence and outcome of subtypes of ischaemic stroke: initial results from the North East Melbourne Stroke Incidence Study (NEMESIS). Cerebrovasc Dis 15:133–139.  https://doi.org/10.1159/000067142 CrossRefGoogle Scholar
  4. 4.
    Glass TA, Hennessey PM, Pazdera L, Chang HM, Wityk RJ, Dewitt LD, Pessin MS, Caplan LR (2002) Outcome at 30 days in the New England medical center posterior circulation registry. Arch Neurol 59:369–376.  https://doi.org/10.1001/archneur.59.3.369 CrossRefGoogle Scholar
  5. 5.
    Cloud GC, Markus HS (2003) Diagnosis and management of vertebral artery stenosis. QJM 96:27–54CrossRefGoogle Scholar
  6. 6.
    Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, Teal P, Dashe JF, Chaves CJ, Breen JC, Vemmos K, Amarenco P, Tettenborn B, Leary M, Estol C, Dewitt LD, Pessin MS (2004) New England Medical Center posterior circulation registry. Ann Neurol 56:389–398.  https://doi.org/10.1002/ana.20204 CrossRefGoogle Scholar
  7. 7.
    Akhtar N, Kamran SI, Deleu D, D’Souza A, Miyares F, ElSotouhy A, al-Hail H, Mesraoua B, Own A, Salem K, Kamha A, Osman Y (2009) Ischaemic posterior circulation stroke in State of Qatar. Eur J Neurol 16:1004–1009.  https://doi.org/10.1111/j.1468-1331.2009.02709.x CrossRefGoogle Scholar
  8. 8.
    Mehndiratta M, Pandey S, Nayak R, Alam A (2012) Posterior circulation ischemic stroke-clinical characteristics, risk factors, and subtypes in a North Indian population: a prospective study. Neurohospitalist 2:46–50.  https://doi.org/10.1177/1941874412438902 CrossRefGoogle Scholar
  9. 9.
    Carpenter MB (1991) Core test of neuroanatomy. 4rd Ed. Williams & Wilkins, BaltimoreGoogle Scholar
  10. 10.
    Neau JP, Bogousslavsky J (1996) The syndrome of posterior choroidal artery territory infarction. Ann Neurol 39:779–788.  https://doi.org/10.1002/ana.410390614 CrossRefGoogle Scholar
  11. 11.
    Thierfelder MK, Baumann AB, Sommer WH et al (2014) Vertebral artery hypoplasia. Frequency and effect on cerebellar blood flow characteristics. Stroke 45:1363–1368.  https://doi.org/10.1161/STROKEAHA.113.004188 CrossRefGoogle Scholar
  12. 12.
    Giannopoulos S, Markoula S, Kosmidou M, Pelidou SH, Kyritsis AP (2007) Lateral medullary ischaemic events in young adults with hypoplastic vertebral artery. J Neurol Neurosurg Psychiatry 78:987–989.  https://doi.org/10.1136/jnnp.2006.106419 CrossRefGoogle Scholar
  13. 13.
    Park JH, Kim JM, Roh JK (2007) Hypoplastic vertebral artery: frequency and associations with ischaemic stroke territory. J Neurol Neurosurg Psychiatry 78:954–958.  https://doi.org/10.1136/jnnp.2006.105767 CrossRefGoogle Scholar
  14. 14.
    Katsanos AH, Kosmidou M, Giannopoulos S (2013) Vertebral artery hypoplasia in posterior circulation cerebral ischemia. Clin Neurol Neurosurg 115:1194–1195.  https://doi.org/10.1016/j.clineuro.2012.08.024 CrossRefGoogle Scholar
  15. 15.
    Watanabe M, Takahashi A, Hashizume Y et al (1992) The correlation between vertebral artery asymmetry and pontine infarction—an MR angiography study. Rinsho Shinkeigaku 32:708–712Google Scholar
  16. 16.
    Friedman DP (1993) Abnormalities of the posterior inferior cerebellar artery: MR imaging findings. AJR Am J Roentgenol 160:1257–1263.  https://doi.org/10.2214/ajr.160.6.8498229 CrossRefGoogle Scholar
  17. 17.
    Alexandrov AV (2011) Cerebrovascular ultrasound in stroke prevention and treatment, 2nd edn. Wiley-Blackwell, HobokenCrossRefGoogle Scholar
  18. 18.
    Gao LY, Guo X, Zhou JJ, Zhang Q, Fu J, Chen WJ, Yang YJ (2013) Basilar artery fenestration detected with CT angiography. Eur Radiol 23:2861–2867.  https://doi.org/10.1007/s00330-013-2890-2 CrossRefGoogle Scholar
  19. 19.
    Hong GM, Chung CS, Bang OY et al (2009) Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts. J Neurol Neurosurg Psychiatry 80:1087–1092.  https://doi.org/10.1136/jnnp.2008.169805 CrossRefGoogle Scholar
  20. 20.
    Dimmick SJ, Faulder KC (2009) Normal variants of the cerebral circulation at multidetector CT angiography. Radiographics 29:1027–1043.  https://doi.org/10.1148/rg.294085730 CrossRefGoogle Scholar
  21. 21.
    Temizöz O, Genchellac H, Unlü E et al (2010) Digital subtraction angiography of a persistent trigeminal artery variant. Diagn Interv Radiol 16:245–247.  https://doi.org/10.4261/1305-3825.DIR.2020-08.1 Google Scholar
  22. 22.
    Meila D, Papke K, Schlunz-Hendann M, Mangold A, Jacobs C, Brassel F (2011) Bilateral persistent trigeminal arteries, one of them ending in the posterior inferior cerebellar artery: case report and review of the literature. Clin Neuroradiol 21:95–99.  https://doi.org/10.1007/s00062-010-0047-0 CrossRefGoogle Scholar
  23. 23.
    Uchino A (2011) Bilateral persistent trigeminal artery variants diagnosed by MR angiography. Cerebellum. 10:745–747.  https://doi.org/10.1007/s12311-011-0284-z CrossRefGoogle Scholar
  24. 24.
    Anderson RA, Sondheimer FK (1976) Rare carotid–vertebrobasilar anastomoses with notes on the differentiation between proatlantal and hypoglossal arteries. Neuroradiology 11:113–118CrossRefGoogle Scholar
  25. 25.
    Consoli A, Cuccuini M, Lorenzini F et al (2012) Anatomical variations of the posterior circulation: case reports and a review of literature. Ital J Anat Embryol 117:13–22Google Scholar
  26. 26.
    Shaban A, Albright KC, Boehme AK, Martin-Schild S (2013) Circle of Willis variants: fetal PCA. Stroke Res Treat 2013:105937.  https://doi.org/10.1155/2013/105937 Google Scholar
  27. 27.
    De Monyé C, Dippel DW, Siepman TA et al (2008) Is a fetal origin of the posterior cerebral artery a risk factor for TIA or ischemic stroke? J Neurol 255:239–245.  https://doi.org/10.1007/s00415-008-0699-8 CrossRefGoogle Scholar
  28. 28.
    Uz A (2007) Variations in the origin of the thalamoperforating arteries. J Clin Neurosci 14:134–137.  https://doi.org/10.1016/j.jocn.2006.01.047 CrossRefGoogle Scholar
  29. 29.
    Griessenauer CJ, Loukas M, Tubbs RS, Cohen-Gadol AA (2014) The artery of Percheron: an anatomic study with potential neurosurgical and neuroendovascular importance. Br J Neurosurg 28:81–85.  https://doi.org/10.3109/02688697.2013.812181 CrossRefGoogle Scholar
  30. 30.
    Lazzaro NA, Wright B, Castillo M, Fischbein NJ, Glastonbury CM, Hildenbrand PG, Wiggins RH, Quigley EP, Osborn AG (2010) Artery of Percheron infarction: imaging patterns and clinical spectrum. AJNR Am J Neuroradiol 31:1283–1289.  https://doi.org/10.3174/ajnr.A2044 CrossRefGoogle Scholar
  31. 31.
    Arauz A, Patiño-Rodríguez HM, Vargas-González JC, Arguelles-Morales N, Silos H, Ruiz-Franco A, Ochoa MA (2014) Clinical spectrum of artery of Percheron infarct: clinical-radiological correlations. J Stroke Cerebrovasc Dis 23:1083–1088.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.09.011 CrossRefGoogle Scholar
  32. 32.
    Lamot U, Ribaric I, Popovic KS (2015) Artery of Percheron infarction: review of literature with a case report. Radiol Oncol 49:141–146.  https://doi.org/10.2478/raon-2014-0037 CrossRefGoogle Scholar
  33. 33.
    Vinod KV, Kaaviya R, Arpita B (2016) Artery of Percheron infarction. Ann Neurosci 23:124–126.  https://doi.org/10.1159/000443570 CrossRefGoogle Scholar
  34. 34.
    Pekcevik Y, Pekcevik R (2014) Variations of the cerebellar arteries at CT angiography. Surg Radiol Anat 36:455–461.  https://doi.org/10.1007/s00276-013-1208-z CrossRefGoogle Scholar
  35. 35.
    Savitz SI, Caplan LR (2005) Vertebrobasilar disease. N Engl J Med 352:2618–2626.  https://doi.org/10.1056/NEJMra041544 CrossRefGoogle Scholar
  36. 36.
    Lee JH, Han SJ, Yun YH, Choi HC, Jung S, Cho SJ, Yu KH, Lee SM, Hwang SH, Song HK, Kwon KH, Lee BC (2006) Posterior circulation ischemic stroke in Korean population. Eur J Neurol 13:742–748.  https://doi.org/10.1111/j.1468-1331.2006.01274.x CrossRefGoogle Scholar
  37. 37.
    Zeng Q, Tao W, Lei C, Dong W, Liu M (2015) Etiology and risk factors of posterior circulation infarction compared with anterior circulation infarction. J Stroke and Cerebrovasc Dis 24:1614–1620.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.03.033 CrossRefGoogle Scholar
  38. 38.
    Labropoulos N, Nandivada P, Bekelis K (2011) Stroke of the posterior cerebral circulation. Int Angiol 30:105–114Google Scholar
  39. 39.
    Solberg LA, Eggen DA (1971) Localization and sequence of development of atherosclerotic lesions in the carotid and vertebral arteries. Circulation 43:711–724CrossRefGoogle Scholar
  40. 40.
    Al-Ali F, Barrow T, Duan L et al (2011) Vertebral artery ostium atherosclerotic plaque as a potential source of posterior circulation ischemic stroke. Result from Borgess Medical Center vertebral artery ostium stenting registry. Stroke 42:2544–2254.  https://doi.org/10.1161/STROKEAHA.110.610451.9 CrossRefGoogle Scholar
  41. 41.
    Caplan LR, Wityk RJ, Pazdera L, Chang HM, Pessin MS, DeWitt L (2005) New England Medical Center Posterior Circulation Stroke Registry II. Vascular lesions. J Clin Neurol 1:31–49.  https://doi.org/10.3988/jcn.2005.1.1.31 CrossRefGoogle Scholar
  42. 42.
    Gorelick PB, Caplan LR, Hier DB, Parker SL, Patel D (1984) Racial differences in the distribution of anterior circulation occlusive disease. Neurology 34:54–59CrossRefGoogle Scholar
  43. 43.
    Sacco RL, Kargman DE, Gu Q, Zamanillo MC (1995) Race ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 26:14–20CrossRefGoogle Scholar
  44. 44.
    Wong LK (2006) Global burden of intracranial atherosclerosis. Int J Stroke 1:158–159.  https://doi.org/10.1111/j.1747-4949.2006.00045.x CrossRefGoogle Scholar
  45. 45.
    De Silva DA, Woon FP, Lee MP et al (2007) South Asian patients with ischemic stroke: intracranial large arteries are the predominant site of disease. Stroke 38:2592–2594.  https://doi.org/10.1161/STROKEAHA.107.484584 CrossRefGoogle Scholar
  46. 46.
    Markus HS, Khan U, Birns J, Evans A, Kalra L, Rudd AG, Wolfe CDA, Jerrard-Dunne P (2007) Differences in stroke subtypes between black and white patients with stroke: the South London Ethnicity and Stroke Study. Circulation 116:2157–2164.  https://doi.org/10.1161/CIRCULATIONAHA.107.699785 CrossRefGoogle Scholar
  47. 47.
    Suri MF, Johnston SC (2009) Epidemiology of intracranial stenosis. J Neuroimaging 19(suppl 1):11S–16S.  https://doi.org/10.1111/j.1552-6569.2009.00415.x CrossRefGoogle Scholar
  48. 48.
    Mazighi M, Labreuche J, Gongora-Rivera F, Duyckaerts C, Hauw JJ, Amarenco P (2008) Autopsy prevalence of intracranial atherosclerosis in patients with fatal stroke. Stroke 39:1142–1147.  https://doi.org/10.1161/STROKEAHA.107.496513 CrossRefGoogle Scholar
  49. 49.
    Baracchini C, Anzola GP, Cenciarelli S, Diomedi M, Bella R, Tonon A, Braga M, Zedde ML, Zanferrari C, del Sette M, Caliandro P, Gandolfo C, Ricci S, Meneghetti G (2016) Italian symptomatic intracranial atherosclerosis study (ISIDE): a multicenter transcranial ultrasound evaluation. Neurol Sci 37:1645–1651.  https://doi.org/10.1007/s10072-016-2642-6 CrossRefGoogle Scholar
  50. 50.
    Qureshi AI, Caplan LR (2014) Intracranial atherosclerosis. Lancet 383:984–998.  https://doi.org/10.1016/S0140-6736(13)61088-0 CrossRefGoogle Scholar
  51. 51.
    Hwang J, Kim SJ, Hong JM, Bang OY, Chung CS, Lee KH, Kim GM (2012) Microembolic signals in acute posterior circulation cerebral ischemia: sources and consequences. Stroke 43:747–752.  https://doi.org/10.1161/STROKEAHA.111.633438 CrossRefGoogle Scholar
  52. 52.
    Paciaroni M, Silvestrelli G, Caso V, Corea F, Venti M, Milia P, Tambasco N, Parnetti L, Gallai V (2003) Neurovascular territory involved in different etiological subtypes of ischemic stroke in the Perugia Stroke Registry. Eur J Neurol 10:361–365CrossRefGoogle Scholar
  53. 53.
    Caplan LR (1989) Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology 39:1246–1250CrossRefGoogle Scholar
  54. 54.
    Kim JS, Yoon Y (2013) Single subcortical infarction associated with parental arterial disease: important yet neglected sub-type of atherothrombotic stroke. Int J Stroke 8:197–203.  https://doi.org/10.1111/j.1747-4949.2012.00816.x CrossRefGoogle Scholar
  55. 55.
    Chung CP, Yong CS, Chang FC, Sheng WY, Huang HC, Tsai JY, Hsu HY, Hu HH (2015) Stroke etiology is associated with outcome in posterior circulation stroke. Ann Clin Transl Neurol 2:510–517.  https://doi.org/10.1002/acn3.188 CrossRefGoogle Scholar
  56. 56.
    Wang X, Fan YH, Lam WW et al (2008) Clinical features, topographic patterns on DWI and etiology of thalamic infarcts. J Neurol Sci 267:147–153.  https://doi.org/10.1016/j.jns.2007.10.014 CrossRefGoogle Scholar
  57. 57.
    Kim HJ, Song JM, Kwon SU, Kim BJ, Kang DH, Song JK, Kim JS, Kang DW (2011) Right-left propensity and lesion patterns between cardiogenic and aortogenic cerebral embolisms. Stroke 42:2323–2325.  https://doi.org/10.1161/STROKEAHA.111.616573 CrossRefGoogle Scholar
  58. 58.
    Kim JS (2003) Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients. Brain 126:1864–1872.  https://doi.org/10.1093/brain/awg169 CrossRefGoogle Scholar
  59. 59.
    Kim JS, Han YS (2009) Medial medullary infarction: clinical, imaging, and outcome study in 86 consecutive patients. Stroke 40:3221–3225.  https://doi.org/10.1161/STROKEAHA.109.559864 CrossRefGoogle Scholar
  60. 60.
    Chang F-C, Yong C-S, Huang H-C, Tsai JY, Sheng WY, Hu HH, Chung CP (2015) Posterior circulation ischemic stroke caused by arterial dissection: characteristics and predictors of poor outcomes. Cerebrovasc Dis 40:144–150.  https://doi.org/10.1159/000437172 CrossRefGoogle Scholar
  61. 61.
    Wl S (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344:898–906.  https://doi.org/10.1056/NEJM200103223441206 CrossRefGoogle Scholar
  62. 62.
    Fusco MR, Harrigan MR (2011) Cerebrovascular dissections—a review part I: spontaneous dissections. Neurosurgery 68:242–257.  https://doi.org/10.1227/NEU.0b013e3182012323 CrossRefGoogle Scholar
  63. 63.
    Yamaura A, Ono J, Hirai S (2000) Clinical picture of intracranial non-traumatic dissecting aneurysm. Neuropathology 20:85–90.  https://doi.org/10.1046/j.1440-1789.2000.00276.x CrossRefGoogle Scholar
  64. 64.
    Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, Benninger D, Sturzenegger M, Mattle HP, Baumgartner RW (2006) Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 37:2499–2503.  https://doi.org/10.1161/01.STR.0000240493.88473.39 CrossRefGoogle Scholar
  65. 65.
    Tsukahara T, Minematsu K (2010) Overview of spontaneous cervicocephalic arterial dissection in Japan. Acta Neurochir Suppl 107:35–40.  https://doi.org/10.1007/978-3-211-99373-6_5 CrossRefGoogle Scholar
  66. 66.
    Kim BM, Kim SH, Kim DI, Shin YS, Suh SH, Kim DJ, Park SI, Park KY, Ahn SS (2011) Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection. Neurology 76:1735–1741.  https://doi.org/10.1212/WNL.0b013e31821a7d94 CrossRefGoogle Scholar
  67. 67.
    Ramgren B, Cronqvist M, Romner B, Brandt L, Holtås S, Larsson EM (2005) Vertebrobasilar dissection with subarachnoid hemorrhage: a retrospective study of 29 patients. Neuroradiology 47:97–104.  https://doi.org/10.1007/s00234-0051346-z CrossRefGoogle Scholar
  68. 68.
    Kennedy F, Lanfranconi S, Hicks C, Reid J, Gompertz P, Price C, Kerry S, Norris J, Markus HS, On behalf of the CADISS Investigators (2012) Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology 79:686–689.  https://doi.org/10.1212/WNL.0b013e318264e36b CrossRefGoogle Scholar
  69. 69.
    Caplan LR (2005) Dilatative arteriopathy (dolichoectasia): what is known and not known. Ann Neurol 57:469–471.  https://doi.org/10.1002/ana.20447 CrossRefGoogle Scholar
  70. 70.
    Laforêt P, Petiot P, Nicolino M, Orlikowski D, Caillaud C, Pellegrini N, Froissart R, Petitjean T, Maire I, Chabriat H, Hadrane L, Annane D, Eymard B (2008) Dilative arteriopathy and basilar artery dolichoectasia complicating late-onset Pompe disease. Neurology 70:2063–2066.  https://doi.org/10.1212/01.wnl.0000313367.09469.13 CrossRefGoogle Scholar
  71. 71.
    Sacconi S, Bocquet JD, Chanalet S, Tanant V, Salviati L, Desnuelle C (2010) Abnormalities of cerebral arteries are frequent in patients with late-onset Pompe disease. J Neurol 257:1730–1733.  https://doi.org/10.1007/s00415-010-5618-0 CrossRefGoogle Scholar
  72. 72.
    Shah H, Liong C, Levy OA, Waters C, Fahn S, Marder K, Kang UJ, Wolf P, Oliva P, Zhang K, Alcalay RN, Gutierrez J (2018) Association of low lysosomal enzymes activity with brain arterial dilatation. Stroke 49:1977–1980.  https://doi.org/10.1161/STROKEAHA.118.021964 CrossRefGoogle Scholar
  73. 73.
    Wolters FJ, Rinkel GJ, Vergouwen MD (2013) Clinical course and treatment of vertebrobasilar dolichoectasia: a systemic review of the literature. Neurol Res 35:131–137.  https://doi.org/10.1179/1743132812Y.0000000149 CrossRefGoogle Scholar
  74. 74.
    Passero SG, Rossi S (2008) Natural history of vertebrobasilar dolichoectasia. Neurology 70:66–72.  https://doi.org/10.1212/01.wnl.0000286947.89193.f3 CrossRefGoogle Scholar
  75. 75.
    Jadeja N, Nalleballe K (2018) Pearls & Oy-sters: Bow hunter syndrome: a rare cause of posterior circulation stroke: do not look the other way. Neurology 91:329–331.  https://doi.org/10.1212/WNL.0000000000006009 CrossRefGoogle Scholar
  76. 76.
    Argentino C, De Michele M, Fiorelli M et al (1996) Posterior circulation infarcts simulating anterior circulation stroke. Perspective of the acute phase. Stroke 27:1306–1309CrossRefGoogle Scholar
  77. 77.
    Tao WD, Liu M, Fisher M, Wang DR, Li J, Furie KL, Hao ZL, Lin S, Zhang CF, Zeng QT, Wu B (2012) Posterior versus anterior circulation infarction: how different are the neurological deficits? Stroke 43:2060–2065.  https://doi.org/10.1161/STROKEAHA.112.652420 CrossRefGoogle Scholar
  78. 78.
    Zürcher E, Richoz B, Faouzi M, Michel P (2019) Differences in ischemic anterior and posterior circulation strokes: a clinico-radiological and outcome analysis. J Stroke Cerebrovasc Dis 28:710–718.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.11.016 CrossRefGoogle Scholar
  79. 79.
    Gulli G, Markus HS (2012) The use of FAST and ABCD2 scores in posterior circulation, compared with anterior circulation, stroke and transient ischaemic attack. J Neurol Neurosurg Psychiatry 83:228–229.  https://doi.org/10.1136/jnnp.2010.222091 CrossRefGoogle Scholar
  80. 80.
    Linfante I, Llinas RH, Schlaug G et al (2001) Diffusion-weighted imaging and National Institutes of Health Stroke Scale in the acute phase of posterior-circulation stroke. Arch Neurol 58:621–628CrossRefGoogle Scholar
  81. 81.
    Olivato S, Nizzoli S, Cavazzuti M, Casoni F, Nichelli PF, Zini A (2016) E-NIHSS: an Expanded National Institutes of Health Stroke Scale weighted for anterior and posterior circulation strokes. J Stroke Cerebrovasc Dis 25:2953–2957.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.08.011 CrossRefGoogle Scholar
  82. 82.
    Searls DE, Pazdera L, Korbel E, Vysata O, Caplan LR (2012) Symptoms and signs of posterior circulation ischemia in the New England Medical Center posterior circulation registry. Arch Neurol 69:346–351.  https://doi.org/10.1001/archneurol.2011.2083 CrossRefGoogle Scholar
  83. 83.
    Paul NL, Simoni M, Rothwell PM, Study OV (2013) Transient isolated brainstem symptoms preceding posterior circulation stroke: a population-based study. Lancet Neurol 12:65–71.  https://doi.org/10.1016/S1474-4422(12)70299-5 CrossRefGoogle Scholar
  84. 84.
    Compter A, Kappelle LJ, Algra A, van der Worp HB (2013) Nonfocal symptoms are more frequent in patients with vertebral artery than carotid artery stenosis. Cerebrovasc Dis 35:378–384.  https://doi.org/10.1159/000348849 CrossRefGoogle Scholar
  85. 85.
    Kong FY, Tao WD, Hao ZL, Liu M (2010) Predictors of one-year disability and death in Chinese hospitalized women after ischemic stroke. Cerebrovasc Dis 29:255–262.  https://doi.org/10.1159/000267852 CrossRefGoogle Scholar
  86. 86.
    Schneider JI, Olshaker JS (2012) Vertigo, vertebrobasilar disease, and posterior circulation ischemic stroke. Emerg Med Clin North Am 30:681–693.  https://doi.org/10.1016/j.emc.2012.06.004 CrossRefGoogle Scholar
  87. 87.
    Kerber KA, Brown DL, Lisabeth LD, Smith MA, Morgenstern LB (2006) Stroke among patients with dizziness, vertigo, and imbalance in the emergency department; a population-based study. Stroke 37:2484–2487.  https://doi.org/10.1161/01.STR.0000240329.48263.0d CrossRefGoogle Scholar
  88. 88.
    Lee H, Sohn SI, Cho YW et al (2006) Cerebellar infarction presenting isolated vertigo: frequency and vascular topographical patterns. Neurology 67:1178–1183.  https://doi.org/10.1212/01.wnl.0000238500.02302.b4 CrossRefGoogle Scholar
  89. 89.
    Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE (2009) HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 40:3504–3510.  https://doi.org/10.1161/STROKEAHA.109.551234 CrossRefGoogle Scholar
  90. 90.
    Vestergaard K, Andersen G, Nielsen MI, Jensen TS (1993) Headache in stroke. Stroke 24:1621–1624CrossRefGoogle Scholar
  91. 91.
    Kase CS, Norrving BO, Levine SR, Babikian VL, Chodosh EH, Wolf PA, Welch KM (1993) Cerebellar infarction. Clinical and anatomic observations in 66 cases. Stroke 24:76–83CrossRefGoogle Scholar
  92. 92.
    Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G (2011) Basilar artery occlusion. Lancet Neurol 10:1002–1014.  https://doi.org/10.1016/S1474-4422(11)70229-0 CrossRefGoogle Scholar
  93. 93.
    Von Campe G, Regli F, Bogousslavsky J (2003) Heralding manifestations of basilar artery occlusion with lethal or severe stroke. J Neurol Neurosurg Psychiatry 74:1621–1626.  https://doi.org/10.1136/jnnp.74.12.1621 CrossRefGoogle Scholar
  94. 94.
    Fugate JE, Rabinstein AA (2015) Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol 14:914–925.  https://doi.org/10.1016/S1474-4422(15)00111-8 CrossRefGoogle Scholar
  95. 95.
    Ropper AH (1988) ‘Convulsions’ in basilar artery occlusion. Neurology 38:1500–1501CrossRefGoogle Scholar
  96. 96.
    Wilson LK, Benavente OR, Woolfenden AR, Asdaghi N (2014) Spontaneous limb movements and posturing secondary to acute basilar artery occlusion: a potentially devastating seizure mimic. Pract Neurol 14:42–44.  https://doi.org/10.1136/practneurol-2013-000585 CrossRefGoogle Scholar
  97. 97.
    Kirchmann M, Thomsen LL, Olesen J (2006) Basilar-type migraine: clinical, epidemiologic, and genetic features. Neurology 66:880–886.  https://doi.org/10.1212/01.wnl.0000203647.48422.dd CrossRefGoogle Scholar
  98. 98.
    Headache Classification Committee of the International Headache Society (IHS) (2013) The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 33:629–808.  https://doi.org/10.1177/0333102413485658 CrossRefGoogle Scholar

Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Division of Neurology with Stroke Unit, Department of NeurosciencesA.O. “San Pio”, P.O. “G. Rummo”,Benevento (BN)Italy
  2. 2.Stroke Unit, Neurology Unit, Department of Neuroscience, Ospedale Civile S. Agostino-EstenseModena University HospitalBaggiovaraItaly
  3. 3.UOC Neurologia e Rete Stroke metropolitana, Ospedale MaggioreIRCCS Istituto di Scienze Neurologiche di BolognaBolognaItaly

Personalised recommendations