Infarctions in the vascular territory of the posterior cerebral artery: clinical features in 232 patients

BMC Research Notes, Sep 2011

Background Ischemic stroke caused by infarction in the territory of the posterior cerebral artery (PCA) has not been studied as extensively as infarctions in other vascular territories. This single centre, retrospective clinical study was conducted a) to describe salient characteristics of stroke patients with PCA infarction, b) to compare data of these patients with those with ischaemic stroke due to middle cerebral artery (MCA) and anterior cerebral artery (ACA) infarctions, and c) to identify predictors of PCA stroke. Findings A total of 232 patients with PCA stroke were included in the "Sagrat Cor Hospital of Barcelona Stroke Registry" during a period of 19 years (1986-2004). Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 232 patients with PCA stroke were compared with those of the 1355 patients with MCA infarctions and 51 patients with ACA infarctions included in the registry. Infarctions of the PCA accounted for 6.8% of all cases of stroke (n = 3808) and 9.6% of cerebral infarctions (n = 2704). Lacunar infarction was the most frequent stroke subtype (34.5%) followed by atherothrombotic infarction (29.3%) and cardioembolic infarction (21.6%). In-hospital mortality was 3.9% (n = 9). Forty-five patients (19.4%) were symptom-free at hospital discharge. Hemianopia (odds ratio [OR] = 6.43), lacunar stroke subtype (OR = 2.18), symptom-free at discharge (OR = 1.92), limb weakness (OR = 0.10), speech disorders (OR = 0.33) and cardioembolism (OR = 0.65) were independent variables of PCA stroke in comparison with MCA infarction, whereas sensory deficit (OR = 2.36), limb weakness (OR = 0.11) and cardioembolism as stroke mechanism (OR = 0.43) were independent variables associated with PCA stroke in comparison with ACA infarction. Conclusions Lacunar stroke is the main subtype of infarction occurring in the PCA territory. Several clinical features are more frequent in stroke patients with PCA infarction than in patients with ischaemic stroke due to infarction in the MCA and ACA territories. In-hospital mortality in patients with PCA territory is low.

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Infarctions in the vascular territory of the posterior cerebral artery: clinical features in 232 patients

BMC Research Notes Infarctions in the vascular territory of the posterior cerebral artery: clinical features in 232 patients Adrià Arboix 0 Guillermo Arbe 0 Luis García-Eroles Montserrat Oliveres 0 Olga Parra Joan Massons 0 0 Unit of Cerebrovascular Diseases, Service of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona , Barcelona , Spain Background: Ischemic stroke caused by infarction in the territory of the posterior cerebral artery (PCA) has not been studied as extensively as infarctions in other vascular territories. This single centre, retrospective clinical study was conducted a) to describe salient characteristics of stroke patients with PCA infarction, b) to compare data of these patients with those with ischaemic stroke due to middle cerebral artery (MCA) and anterior cerebral artery (ACA) infarctions, and c) to identify predictors of PCA stroke. Findings: A total of 232 patients with PCA stroke were included in the “Sagrat Cor Hospital of Barcelona Stroke Registry” during a period of 19 years (1986-2004). Data from stroke patients are entered in the stroke registry following a standardized protocol with 161 items regarding demographics, risk factors, clinical features, laboratory and neuroimaging data, complications and outcome. The characteristics of these 232 patients with PCA stroke were compared with those of the 1355 patients with MCA infarctions and 51 patients with ACA infarctions included in the registry. Infarctions of the PCA accounted for 6.8% of all cases of stroke (n = 3808) and 9.6% of cerebral infarctions (n = 2704). Lacunar infarction was the most frequent stroke subtype (34.5%) followed by atherothrombotic infarction (29.3%) and cardioembolic infarction (21.6%). In-hospital mortality was 3.9% (n = 9). Forty-five patients (19.4%) were symptom-free at hospital discharge. Hemianopia (odds ratio [OR] = 6.43), lacunar stroke subtype (OR = 2.18), symptom-free at discharge (OR = 1.92), limb weakness (OR = 0.10), speech disorders (OR = 0.33) and cardioembolism (OR = 0.65) were independent variables of PCA stroke in comparison with MCA infarction, whereas sensory deficit (OR = 2.36), limb weakness (OR = 0.11) and cardioembolism as stroke mechanism (OR = 0.43) were independent variables associated with PCA stroke in comparison with ACA infarction. Conclusions: Lacunar stroke is the main subtype of infarction occurring in the PCA territory. Several clinical features are more frequent in stroke patients with PCA infarction than in patients with ischaemic stroke due to infarction in the MCA and ACA territories. In-hospital mortality in patients with PCA territory is low. Background Knowledge of the clinical features of cerebral infarctions according to the affected vascular territory is important to characterize the diverse spectrum of symptoms associated with the vascular topography of lesions. Infarctions in the territory of the posterior cerebral artery (PCA) are not uncommon [ 1 ] but some aspects of the natural history of PCA infarction, such as aetiology, clinical features and outcome have not been sufficiently documented. In many studies, patients with PCA infarction are included in group of hemispheric cerebral infarction as a whole, independently of the different vascular topography of lesions [ 1-3 ]. Moreover, the differential clinical profile between ischaemic stroke caused by PCA infarctions, middle cerebral artery (MCA) infarctions and anterior cerebral artery (ACA) infarctions is poorly defined, probably because separate analysis of PCA stroke as an individual clinical entity is rarely performed. This single centre, retrospective clinical study was conducted with the following aims: a) to describe salient characteristics of stroke patients with PCA infarction, b) to compare data of these patients with those with ischaemic stroke due to middle cerebral artery (MCA) and anterior cerebral artery (ACA) infarctions, and c) to identify predictors of PCA stroke. Methods The database of the “Sagrat Cor Hospital of Barcelona Stroke Registry” with data of 3808 acute stroke patients was searched for those with a diagnosis of ischaemic stroke caused by occlusion in the territory of the PCA who were admitted consecutively to the Department of Neurology of the Sagrat Cor Hospital (an acute-care 350bed teaching hospital in the city of Barcelona) between January 1986 and December 2004. Details of this on-going hospital-based stroke registry have been previously reported [ 4 ]. Classification of subtypes of stroke and definitions of vascular risk factors were those recommended by the Cerebrovascular Study Group of the Spanish Society of Neurology [ 5 ] and have been used in previous studies [ 4,6,7 ]. The objective of this clinical study was to assess differential features in aetiology, risk factors, clinical findings and early outcome between patients with PCA stroke and those with MCA and PCA infarctions. To this purpose, All patients with ischaemic (...truncated)


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Adrià Arboix, Guillermo Arbe, Luis García-Eroles, Montserrat Oliveres, Olga Parra, Joan Massons. Infarctions in the vascular territory of the posterior cerebral artery: clinical features in 232 patients, BMC Research Notes, 2011, pp. 329, Volume 4, Issue 1, DOI: 10.1186/1756-0500-4-329