Posterior cerebral artery (PCA) infarct
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At the time the article was created Anon Ny Mous had no recorded disclosures.
View Anon Ny Mous's current disclosuresAt the time the article was last revised Craig Hacking had the following disclosures:
- Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)
These were assessed during peer review and were determined to not be relevant to the changes that were made.
View Craig Hacking's current disclosures- Posterior cerebral artery infarction
- PCA infarction
- PCA infarct
- PCA infarcts
Posterior cerebral artery (PCA) infarcts arise, as the name says, from occlusion of the posterior cerebral artery. It is a type of posterior circulation infarction.
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Epidemiology
Posterior cerebral artery strokes are believed to comprise approximately 5-10% of ischemic strokes 6.
Clinical presentation
Symptoms of posterior cerebral artery stroke include contralateral homonymous hemianopia (due to occipital infarction), hemisensory loss (due to thalamic infarction) and hemi-body pain (usually burning in nature and due to thalamic infarction) 3. If bilateral, often there is reduced visual-motor coordination 3. It is generally considered that sensory loss and hemianopia unilaterally without paralysis, is diagnostic of PCA territory stroke 4.
Because the PCA supplies the thalamus, PCA infarction can lead to contralateral thalamic syndrome.
Pathology
The most common causes of PCA strokes include atherosclerosis, small artery disease and embolism 5.
Treatment and prognosis
Depending on the timing (within 4.5 hours), patients may be eligible for thrombolysis (c. 2012) 4. If they present after this window, patients may be suitable candidates for endovascular treatments (including stenting, angioplasty, mechanical embolectomy, etc.), however, evidence for mechanical thrombectomy in PCA strokes has not yet been fully established (c. 2021) as all major thrombectomy trials did not include strokes involving the posterior circulation 5, 6.
The size of the vessel and unclear symptoms onset can make the treatment of acute ischemic stroke challenging 5.
Quiz questions
References
- 1. Ryan D, Murphy SM, Hennessey MJ. Bilateral posterior cerebral artery infarction. BMJ Case Rep. 2010;2010 (nov30 1): . doi:10.1136/bcr.03.2010.2798 - Free text at pubmed - Pubmed citation
- 2. Finelli PF. Neuroimaging in acute posterior cerebral artery infarction. Neurologist. 2008;14 (3): 170-80. doi:10.1097/NRL.0b013e3181627679 - Pubmed citation
- 3. Merwick Á, Werring D. Posterior circulation ischaemic stroke. BMJ. 2014;348 (may19 33): g3175. doi:10.1136/bmj.g3175 - Pubmed citation
- 4. Searls DE, Pazdera L, Korbel E et-al. Symptoms and signs of posterior circulation ischemia in the new England medical center posterior circulation registry. (2012) Archives of neurology. 69 (3): 346-51. doi:10.1001/archneurol.2011.2083 - Pubmed
- 5. Okkes Kuybu, Rimal H. Dossani. Posterior Cerebral Artery Stroke. (2018) Pubmed
- 6. Memon MZ, Kushnirsky M, Brunet MC, Saini V, Koch S, Yavagal DR. Mechanical thrombectomy in isolated large vessel posterior cerebral artery occlusions. (2021) Neuroradiology. 63 (1): 111-116. doi:10.1007/s00234-020-02505-w - Pubmed
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- signs
- by region
- hemispheric infarcts
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- pontine infarct
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- Gasperini syndrome: basilar artery or AICA
- inferior medial pontine syndrome (Foville syndrome): basilar artery
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- locked-in syndrome: basilar artery
- Millard-Gubler syndrome: basilar artery
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- medullary infarct
- Babinski-Nageotte syndrome
- Cestan-Chenais syndrome
- hemimedullary syndrome (Reinhold syndrome)
- lateral medullary stroke syndrome (Wallenberg syndrome)
- medial medullary syndrome (Déjerine syndrome)
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- midbrain infarct
- acute spinal cord ischemia syndrome
- hemispheric infarcts
- by vascular territory
- by vessel size
- treatment options
- complications
-
intracranial hemorrhage
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intra-axial hemorrhage
- signs and formulas
- ABC/2 (volume estimation)
- black hole sign
- blend sign
- cashew nut sign
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- satellite sign
- swirl sign
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- by type
- by location
- signs and formulas
- extra-axial hemorrhage
- extradural hemorrhage (EDH)
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- subdural hemorrhage (SDH)
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subarachnoid hemorrhage (SAH)
- types
- complications
- grading systems
- subpial hemorrhage
-
intra-axial hemorrhage