Posterior cerebral artery (PCA) infarct

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.

Posterior cerebral artery strokes are believed to comprise approximately 5-10% of ischemic strokes 6.

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.

The most common causes of PCA strokes include atherosclerosis, small artery disease and embolism 5.

Depending on the timing (within 4.5 hours), patients may be eligible for thrombolysis 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 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.

Stroke and intracranial haemorrhage

Article information

rID: 1809
Synonyms or Alternate Spellings:
  • Posterior cerebral artery infarction
  • PCA infarction
  • PCA infarct
  • PCA infarcts

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Cases and figures

  • Figure 1: vascular territories
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  • Case 1: DWI
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  • Figure 2: vascular territories
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  • Case 1: FLAIR
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  • Figure 3: vascular territories
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  • Case 2: subacute FLAIR
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  • Case 3: with artery of Percheron infarct
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  • Case 4
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  • Case 5: DWI
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  • Case 6: early
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  • Case 7
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  • Case 8: chronic bilateral occipital lobe infarcts
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  • Case 9
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  • Case 10: acute left PCA infarct
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  • Case 11: due to SDH and raised ICP
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  • Case 12
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  • Case 13: with hyperdense PCA sign
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