Symptoms and Signs in Early Vertebrobasilar Territory Stroke
Within the posterior circulation, as in the anterior circulation, most acute brain infarcts are caused by thrombi within intracranial arteries. These thrombi can form in situ (“thrombosis”) within the intracranial arteries or represent emboli that have arisen from the heart, aorta, or proximal cervicocranial arteries. The possible exception is infarction in the distribution of single penetrating or circumferential branch arteries; such infarctions are often caused by luminal compromise by plaques and changes within the vessel walls . Individuals of Japanese, Chinese, and Thai origin and African-Americans are more likely to have occlusive changes within intracranial posterior circulation arteries and branches, especially the distal basilar artery and the posterior inferior cerebellar arteries (PICAs), than are comparable Caucasian populations [2,3]. Thrombolysis is likely to have a different effectiveness in patients who have emboli to previously normal intracranial arteries (the entire intraluminal lesion representing a thrombus) compared to those patients that have important prior luminal narrowing caused by plaque (the occlusive lesion representing plaque plus thrombus). In this chapter, I concentrate on reviewing the clinical symptoms and signs in patients with acute occlusions of the intracranial vertebral arteries (ICVAs) and the basilar artery (BA), because they are the patients in whom thrombolysis is most likely to be feasible and therapeutically successful, and contrast the findings in patients with ICVA and BA occlusion to those found in patients with atheromatous branch disease and lacunar infarction.
KeywordsBasilar Artery Posterior Inferior Cerebellar Artery Contralateral Limb Sixth Cranial Nerve Palsy Basilar Artery Occlusion
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- 5.Chaves C, Caplan LR, Chung C-S, Amarenco P (1994) Cerebellar infarcts. In: Appel S (ed) Current neurology, vol 14. Mosby, St Louis, pp 143–177Google Scholar
- 7.Caplan LR, Pessin MS, Mohr JP (1992) Vertebrobasilar occlusive disease. In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM (eds) Stroke: Pathophysiology, diagnosis and management, 2nd edn. Churchill Livingstone, New York, pp 443–515Google Scholar
- 8.Currier R, Giles C, Dejong R (1961) Some comments on Wallenberg’s lateral medullary syndrome. Neurology 12: 778–791Google Scholar
- 11.Caplan LR (1993) Stroke. A clinical approach, 2nd edn. Butterworth, Boston, p 256Google Scholar
- 15.Caplan LR (1995) Posterior cerebral artery territory ischemia. In: Bogousslaysky J, Caplan LR (eds) Stroke syndromes. Cambridge University Press, London, pp 290–299Google Scholar
- 18.Pullicino PM (1993) The course and territories of cerebral small arteries. In: Pullicino PM, Caplan LR, Hommel M (eds) Advances in neurology, vol 62. Cerebral small artery disease. Raven, New York, pp 11–72Google Scholar