Posterior Cerebral Artery Territory Infarcts: Clinical Features, Infarct Topography, Causes and Outcome<footref rid="foot01">¹</footref>

Abstract

Only a few large series of posterior cerebral artery (PCA) stroke exist, and clinical features and causes have not been studied as extensively as in other vascular territories. The PCA syndrome includes more clinical signs than the well-known visual field deficits. Concomitant findings are frequently sensory, slight motor and neuropsychological deficits. Unilateral headaches are the common presenting symptom making complicated migraine an important differential diagnosis. Combined deep and superficial PCA territory infarcts involving the lateral thalamus are more frequent than commonly assumed and are mostly associated with sensory and reversible slight motor deficits. Occlusion of the precommunal PCA segment with associated paramedian midbrain infarction causes severe motor deficits, oculomotor signs, and decreased consciousness and has a poorer outcome than other PCA territory infarcts. Embolism from a cardiac or undetermined source is the leading mechanism accounting for up to half of the cases, whereas arterial embolism from significant proximal vertebrobasilar disease is less frequent. Local atherothrombotic stenosis or occlusion of the PCA is uncommon. In spite of thorough diagnostic evaluation, the etiology of PCA territory infarction cannot be determined in at least one quarter of patients. Among the rare causes of PCA territory infarction carotid artery disease is important while the significance of migraine remains controversial.

Acute bilateral vision loss in Emergency Department: A case report

“…Although patients with PCA infarction usually suffer from unilateral headache, clinical signs are visual defects with contralateral homonymous hemianopia and unilateral cortical blindness. 7 Therefore, in bilateral visual defect, if eye and pupil examinations are normal "cortical blindness" that is the partial or complete loss of vision in the normal-appearing eye and occurs due to damaged visual field in the occipital cortex of the brain should be considered. 8 There were similar findings in our patient.…”

Intra-arterial Thrombolysis

“…Different patterns include caudal vertebrobasilar, mid-basilar and top-of-the-basilar thrombosis, the former mostly being of atherothrombotic and the latter of embolic origin. 4 Multiple case series mostly addressing intraarterial (IA) and less frequently intravenous 5 thrombolytic therapy for BAT have been published in the last 20 years, the first report by Zeumer et al dating back to 1982. 6,7 Most studies suffered from small numbers: Ͻ10 patients with only a few in the range of 40 to 50 patients.…”

Doutor, não consigo ver! Um caso de cegueira cortical bilateral

“…The most common cause of cortical blindness is occipital lobe infarction in the vascular territory of the posterior cerebral arteries (PCA) 1,2 , but other etiologies include: posterior reversible encephalopathy syndrome, trauma, infections and neoplasms.…”

“…PCA infarction occurs in about 5-10% of all ischemic strokes and is most often secondary to emboli from the heart or vertebrobasilar circulation 2 . The etiology of the infarction cannot be determined in at least 25% to 38% of patients 2,3 .…”

“…The etiology of the infarction cannot be determined in at least 25% to 38% of patients 2,3 . The prevalence of bilateral occipital infarction is not know and appears to be very rare 1 , but is a medical emergency and should be considered an important differential diagnosis for sudden onset bilateral blindness.…”