Posterior circulation cerebral infarction

Patients with posterior circulation ischemic cerebral infarction generally account for about a quarter of the ischemic infarction population. It is a major type of cerebral infarction disease, especially common in foreign populations. The function of the posterior circulation area of ​​the human brain is quite important. Once a blood vessel blockage occurs and is not treated in time, it will cause obvious harm to the human body and the consequences are often not optimistic. So, how to accurately diagnose this disease?

1. Concept

Posterior circulation cerebral infarction usually refers to small and medium-sized infarctions caused by occlusion of the vertebral basilar artery and its branches. The posterior circulation supplies blood to the posterior 2/5 of the cerebral hemispheres (occipital lobe and medial temporal lobe), thalamus, posterior 1/3 of the posterior limb of the internal capsule, the entire brainstem, and cerebellum.

2. Causes

The most common causes of posterior circulation ischemic stroke are vertebrobasilar (including the brainstem, cerebellum, midbrain, thalamus, part of the temporal lobe, and occipital lobe) arterial occlusion caused by atherosclerotic plaque formation or arterial dissection, and arterial embolism caused by detachment of cardiac emboli.

3. Hazards

And the treatment effect is often poor. Delayed or misdiagnosis may lead to serious consequences. When acute treatment or secondary prevention measures are not implemented in time, unnecessary death or serious disability may occur. The recurrence rate of posterior circulation ischemic stroke is higher than that of anterior circulation stroke, especially in patients with vertebral-basilar artery stenosis. The recurrence rate increased threefold.

Symptoms

1. Lateral medulla oblongata (intracranial vertebral artery infarction, also known as dorsolateral medullary syndrome): nystagmus, vertigo, ipsilateral Horner's syndrome, ipsilateral facial sensory loss, dysarthria, hoarseness, dysphagia, and loss of pain and temperature sensation in the contralateral limbs.

2. Medial medulla oblongata: paralysis of the ipsilateral tongue muscles, which gradually atrophy in the later stage; mild paralysis of the contralateral upper and (or) lower limbs; unilateral loss of tactile and proprioception.

3. Pons: hemiplegia or hemisensory disturbance, mixed mild paresis, dysarthria, horizontal gaze paralysis; locked-in syndrome, quadriplegia, aphasia, preserved consciousness and cognitive function, preserved vertical eye movement.

4. Basilar artery apex: lethargy, confusion (thalamic infarction); bilateral visual field loss, unawareness or denial of visual field loss (bilateral occipital lobe infarction). 5. Posterior inferior cerebellar artery: trunk ataxia, vertigo (when the inferior cerebellar peduncle is involved, it may be accompanied by limb ataxia).

5. Posterior cerebral artery: contralateral homonymous hemianopsia (occipital lobe infarction); hemisensory loss (thalamic infarction); hemiplegic pain caused by thalamic infarction (thalamic pain); if both sides are affected, it may be accompanied by visual distortion and visual agnosia.

5. Diagnosis

1. Compared with other types of ischemic stroke, posterior circulation ischemic stroke is relatively difficult to diagnose.

2. The diagnosis of posterior circulation ischemic stroke is mainly based on the rapid development of clinical signs caused by focal cerebral functional damage and the exclusion of other non-vascular causes.

6. Treatment

1. Patients with hydrocephalus or increased intracranial pressure need to undergo neurosurgery as soon as possible.

2. If the patient develops symptoms such as acute coma, dysarthria, abnormal eye movements, etc., he or she should seek treatment from a stroke specialist immediately.

3. In the acute phase of posterior circulation stroke, it is crucial to stabilize the condition, prevent aggravation and restore symptoms.