Posterior circulation ischaemic stroke – clinical, radiological and risk factor profile

Introduction: Stroke is a major cause of mortality and morbidity in India. Posterior circulation strokes represent approximately 20% of all the ischemic strokes. It is a clinical syndrome associated with ischemia due to embolic occlusion, stenos is or thrombosis of the posterior circulation arteries such as the vertebral, basilar, posterior cerebral arteries and their branches. Many patients can present with complaints of vertigo, nausea and vomiting which could be misdiagnosed as labyrinthine or vestibular disorders. This study was done to establish the clinical profile and risk factors profile of posterior circulation ischemic stroke.
Materials: This observational retrospective study was performed in the Department of Neurology at SRMSIMS, Bareilly for duration of 24 months (February 2018 to March 2020). Patients of posterior circulation ischemic stroke patients with age more than 18 years who were admitted in neurology ward, meeting the inclusion criteria were studied .Their clinical presentations and risk factor profile was analyzed. A total of 330 ischemic stroke cases were admitted during this period, 41 out of which had posterior circulation stroke.
Observations: The age group of the cases with posterior circulation ischemic stroke ranged from 32-82 years with a mean age of 57. A male predominance was seen with a Male: female ratios of 4:1.Amongst the risk factors in the subjects, hypertension, diabetes mellitus and previous history of stroke were most common. Alcohol consumption, smoking and dyslipidemia were present in 40% of the subjects .It was observed that the majority of the cases had vertigo (58%), which was followed by motor weakness (51%), slurred speech (43%), headache (43%) and ataxia (48%).Cerebellar infarct was the most common radiological pattern of the posterior circulation ischemic stroke and was seen in 60% of cases. The mortality rate was 14.7% in our study.
Conclusions: Posterior circulation stroke patients presented with a variety of symptoms. It was analyzed that a significant proportion of the total stroke cases were attributable to PCS which usually occurred after 50 years of age and was more common in elderly men .Ischemic type of posterior circulation stroke and infratentorial site (cerebellum) were the most common findings .CT and MRI were useful in the early diagnosis of stroke . Early recognition, prompt care and management are necessary for a better outcome in PCS patients.