Posterior Circulation Stroke and Vertebrobasilar Insufficiency

Catheter ablation of atrial fibrillation (AF) has established itself as a safe and proven rhythm control strategy for selected patients with AF over the past decade. Thromboembolic complications of catheter ablation are becoming rare in anticoagulated patients with a risk of stroke reported as 0.3%. A particular challenge is posed by clinical presentation due to ischaemic stroke involving the posterior circulation following catheter ablation because of its substantial differences from the carotid territory stroke, making the timely diagnosis and treatment very difficult. It is crucial to keep an index of clinical suspicion in patients presenting with neurological deficits related to vertebrobasilar circulation following ablation. We describe the case of a man who presented with dizziness and palpitations after radiofrequency catheter ablation of AF. He was found to be in AF with a rapid ventricular response. His dizziness was initially attributed to the cardiac dysrhythmia. As his symptoms continued despite heart rate control, he underwent further investigations and was eventually diagnosed with a posterior circulation stroke resulting in left cerebellar infarction. He was treated with antiplatelet therapy and improved significantly over the following few days. We review and present an up-to-date brief literature review on the complications of catheter ablation of AF and describe pathophysiology, clinical features, diagnosis and treatment options for posterior circulation stroke after AF ablation. This case aims to raise awareness among clinicians about posterior circulation stroke after AF ablation.

Download Full-text

An Attempt to Define Mechanical Thrombectomy in Posterior Circulation Stroke: Insights from STAR

World Neurosurgery ◽

10.1016/j.wneu.2021.01.106 ◽

2021 ◽

Vol 147 ◽

pp. 215-216

Author(s):

Mithun G. Sattur ◽

Ali M. Alawieh ◽

Alejandro M. Spiotta

Keyword(s):

Mechanical Thrombectomy ◽

Posterior Circulation ◽

Posterior Circulation Stroke

Download Full-text

APICAL PLEURAL ASPERGILLOSIS WITH PANCOAST'S SYNDROME AND POSTERIOR CIRCULATION STROKE: A CASE REPORT

Journal de Mycologie Médicale ◽

10.1016/j.mycmed.2021.101154 ◽

2021 ◽

pp. 101154

Author(s):

Y Muralidhar Reddy ◽

Subhendu Parida ◽

Premchand Gupta ◽

Shyam K Jaiswal ◽

Ganjisreenivasa Gnaneswar ◽

...

Keyword(s):

Case Report ◽

Posterior Circulation ◽

Posterior Circulation Stroke

Download Full-text

Intravenous thrombolysis outcome in posterior vs anterior circulation stroke in a tertiary stroke center in Egypt

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00325-0 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Nourhan Abdelmohsen Taha ◽

Hala El Khawas ◽

Mohamed Amir Tork ◽

Tamer M. Roushdy

Keyword(s):

Intravenous Thrombolysis ◽

Posterior Circulation ◽

University Hospitals ◽

Stroke Patients ◽

Anterior Circulation ◽

Time Points ◽

Posterior Circulation Stroke ◽

First Line Therapy ◽

Insignificant Difference ◽

Stroke Center

Abstract Background Intravenous thrombolysis (IVT) with alteplase is the first-line therapy for acute ischemic anterior and posterior circulation strokes (ACS and PCS). Knowledge about safety and efficacy of IVT in posterior circulation stroke is deficient as most of the Egyptian studies either assessed IVT outcome in comparison to conservative therapy or its outcome in anterior circulation stroke only. Therefore, our aim was to compare the relative frequency and outcome after intravenous thrombolysis in anterior versus posterior circulation stroke patients presenting to stroke centers of Ain Shams University hospitals (ASUH). Results A total of 238 anterior circulation stroke and 61 posterior circulation strokes were enrolled, onset-to-door and door-to-needle time were statistically insignificant. NIHSS showed comparable difference at all time points despite higher scores along anterior circulation stroke; 90-day modified Rankin Scale (mRS) showed significant improvement in both groups from mRS >2 to ≤2 with a better percentage along posterior circulation stroke patients. There was insignificant difference for either incidence of death or intracranial hemorrhage (ICH) between the two groups. Conclusion IVT significantly reduced NIHSS for both anterior and posterior circulation stroke along different studied time points. Meanwhile, a higher percentage of patients with posterior circulation stroke had a better mRS outcome at 90 days.

Download Full-text

Teaching NeuroImages: Bilateral hypertrophic olivary degeneration following posterior circulation stroke

Neurology ◽

10.1212/wnl.0000000000004605 ◽

2017 ◽

Vol 89 (18) ◽

pp. e224-e225 ◽

Cited By ~ 1

Author(s):

Manchikanti Venkatesh ◽

V.R. Shiva Prasad ◽

S. Umar Basha ◽

G.H. Jhansi Priya

Keyword(s):

Posterior Circulation ◽

Hypertrophic Olivary Degeneration ◽

Posterior Circulation Stroke

Download Full-text

Posterior Circulation Stroke is Associated with Prolonged Door-to-Needle Time

International Journal of Stroke ◽

10.1111/j.1747-4949.2012.00952.x ◽

2013 ◽

Vol 10 (5) ◽

pp. 672-678 ◽

Cited By ~ 39

Author(s):

Amrou Sarraj ◽

Sarah Medrek ◽

Karen Albright ◽

Sheryl Martin-Schild ◽

Wafi Bibars ◽

...

Keyword(s):

Posterior Circulation ◽

Posterior Circulation Stroke

Download Full-text

Cerebral Blood Flow Volume in Posterior Circulation Ischemic Disorders

Journal for Vascular Ultrasound ◽

10.1177/15443167211053911 ◽

2021 ◽

pp. 154431672110539

Author(s):

Anastasiya Yu. Vishnyakova ◽

Nataliya M. Medvedeva ◽

Alexander B. Berdalin ◽

Svetlana E. Lelyuk ◽

Vladimir G. Lelyuk

Keyword(s):

Blood Flow ◽

Healthy Volunteers ◽

Internal Carotid ◽

Duplex Sonography ◽

Posterior Circulation ◽

Control Group ◽

Vertebrobasilar Insufficiency ◽

Flow Volume ◽

Blood Flow Volume ◽

Vertebral Arteries

Objective: The aim of this study was to determine blood flow volume (BFV) in the normal state and its features in patients with acute posterior circulation ischemic strokes (PCIS) and vertebrobasilar insufficiency (VBI) using color duplex sonography (DS).Methods: The study included DS data from 96 patients with verified PCIS (66 men and 30 women, aged 64±13 years) and 29 adults with VBI (17 men and 12 women, aged 66±11 years). The control group consisted of 65 healthy male volunteers of different ages.Results: In asymptomatic healthy volunteers, there was a significant decrease in BFV in the internal carotid artery (ICA) with age (502 ml/min in young people, 465 ml/min in the older subgroup) with rS = −0.24 ( p = 0.05), and the aggregated BFV in the vertebral arteries (VAs) turned out to be almost constant (141–143 ml/min). In patients with VBI, the aggregated BFV in the VAs (144 ml/min) did not differ from that in healthy volunteers, but the BFV values in the ICAs were significantly lower (325 ml/min). In patients with PCIS, the aggregated BFV in the ICAs was also significantly lower (399 ml/min) than in the control group but did not significantly differ from that in patients with VBI. In patients with PCIS, there was a significant decrease in the aggregated BFV in the VAs (105 ml/min), which distinguished this group from other examined patients.Conclusions: A significant decrease the BFV in the VA was observed only in patients with PCIS and was associated with the presence of steno-occlusive diseases (SOD) more often in the left VA. Patients with VBI had the most pronounced decrease in BFV in the ICA.

Download Full-text