Infarction Patterns in Posterior Cerebral Circulation: Etiology and Prognosis

The neurological determination of death in patients with isolated brainstem lesions or by disruption of the posterior cerebral circulation is uncommon and many intensivists may never see such a case in their career. It is also the only major difference between the “whole brain” and “brain stem” formulations for the neurological determination of death. We present a case of a patient with infarction of the structures supplied by the posterior cerebral circulation in whom death was diagnosed using neurological criteria, to illustrate the issues involved. We also suggest that international consensus may be achieved if ancillary tests, such as CT angiography, are made mandatory in this situation o demonstrate loss of blood flow in the anterior cerebral circulation as well the posterior circulation.

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Dimensions of the posterior cerebral circulation: an analysis based on advanced non-invasive imaging

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2012-010549 ◽

2012 ◽

Vol 5 (6) ◽

pp. 597-600 ◽

Cited By ~ 7

Author(s):

Ansaar T Rai ◽

Daniel Rodgers ◽

Eric A Williams ◽

Jeffery P Hogg

Keyword(s):

Cerebral Circulation ◽

Non Invasive ◽

Posterior Cerebral Circulation

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Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries

Journal of Neurosurgery ◽

10.3171/jns.1993.78.2.0192 ◽

1993 ◽

Vol 78 (2) ◽

pp. 192-198 ◽

Cited By ~ 206

Author(s):

Randall T. Higashida ◽

Fong Y. Tsai ◽

Van V. Halbach ◽

Christopher F. Dowd ◽

Tony Smith ◽

...

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Cerebral Circulation ◽

Transluminal Angioplasty ◽

Content Type ◽

Atherosclerotic Stenosis ◽

Basilar Arteries ◽

Posterior Cerebral Circulation ◽

Fine Print

✓ Transluminal angioplasty for hemodynamically significant stenosis (> 70%) involving the posterior cerebral circulation is now being performed by the authors in selected cases. A total of 42 lesions affecting the vertebral or basilar artery have been successfully treated by percutaneous transluminal angioplasty techniques in 41 patients. The lesions involved the proximal vertebral artery in 34 cases, the distal vertebral artery in five, and the basilar artery in three. Patients were examined clinically at 1 to 3 and 6 to 12 months after angioplasty. Three (7.1%) permanent complications occurred, consisting of stroke in two cases and vessel rupture in one. There were four (9.5%) transient complications (< 30 minutes): two cases of vessel spasm and two of cerebral ischemia. Clinical follow-up examination demonstrated improvement of symptoms in 39 cases (92.9%). Radiographic follow-up studies demonstrated three cases (7.1 %) of restenosis involving the proximal vertebral artery; two were treated by repeat angioplasty without complication, and the third is being followed clinically while the patient remains asymptomatic. In patients with significant atherosclerotic stenosis involving the vertebral or basilar artery territories, transluminal angioplasty may be of significant benefit in alleviating symptoms and improving blood flow to the posterior cerebral circulation.

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Artery of Percheron infarction: review of literature with a case report

Radiology and Oncology ◽

10.2478/raon-2014-0037 ◽

2015 ◽

Vol 49 (2) ◽

pp. 141-146 ◽

Cited By ~ 19

Author(s):

Urska Lamot ◽

Ivana Ribaric ◽

Katarina Surlan Popovic

Keyword(s):

Computed Tomography ◽

Case Report ◽

Clinical Features ◽

Cerebral Circulation ◽

Brain Ct ◽

Ischemic Infarction ◽

Artery Of Percheron ◽

Imaging Approach ◽

Intracranial Arteries ◽

Posterior Cerebral Circulation

Abstract Background. Clinical features indicating an ischemic infarction in the territory of posterior cerebral circulation require a comprehensive radiologic examination, which is best achieved by a multi-modality imaging approach (computed tomography [CT], CT-perfusion, computed tomography angiography [CTA], magnetic resonance imaging [MRI] and diffusion weighted imaging [DWI]). The diagnosis of an acute ischemic infarction, where the damage of brain tissue may still be reversible, enables selection of appropriate treatment and contributes to a more favourable outcome. For these reasons it is essential to recognize common neurovascular variants in the territory of the posterior cerebral circulation, one of which is the artery of Percheron. Case report. A 69 year-old woman, last seen awake 10 hours earlier, presented with two typical clinical features of the artery of Percheron infarction, which were vertical gaze palsy and coma. Brain CT and CTA of neck and intracranial arteries upon arrival were interpreted as normal. A new brain CT scan performed 24 hours later revealed hypodensity in the medial parts of thalami. Other imaging modalities were not performed, due to the presumption that the window for the application of effective therapy was over. The diagnosis of an artery of Percheron infarction was therefore made retrospectively with the re-examination of the CTA of neck and intracranial arteries. Conclusions. A multi-modality imaging approach is necessary in every patient with suspicion of the posterior circulation infarction immediately after the onset of symptoms, especially in cases where primary imaging modalities are unremarkable and clinical features are severe, where follow-up examinations are indicated.

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Relationship between visual field defect and arterial occlusion in the posterior cerebral circulation

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.37.9.1022 ◽

1974 ◽

Vol 37 (9) ◽

pp. 1022-1030 ◽

Cited By ~ 20

Author(s):

S. N. Kaul ◽

G. H. D. Boulay ◽

B. E. Kendall ◽

R. W. R. Russell

Keyword(s):

Visual Field ◽

Visual Field Defect ◽

Cerebral Circulation ◽

Arterial Occlusion ◽

Posterior Cerebral Circulation ◽

Field Defect

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Are morphologic features of recent small subcortical infarcts related to specific etiologic aspects?

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286419835716 ◽

2019 ◽

Vol 12 ◽

pp. 175628641983571 ◽

Cited By ~ 3

Author(s):

Sebastian Eppinger ◽

Thomas Gattringer ◽

Lena Nachbaur ◽

Simon Fandler ◽

Lukas Pirpamer ◽

...

Keyword(s):

Risk Factors ◽

Basal Ganglia ◽

Cerebral Circulation ◽

Vascular Risk Factors ◽

Large Artery ◽

Vascular Risk ◽

Mri Features ◽

Artery Disease ◽

Brain Artery ◽

Posterior Cerebral Circulation

Background: Recent small subcortical infarcts (RSSIs) mostly result from the occlusion of a single, small, brain artery due to intrinsic cerebral small-vessel disease (CSVD). Some RSSIs may be attributable to other causes such as cardiac embolism or large-artery disease, and their association with coexisting CSVD and vascular risk factors may vary with morphological magnetic resonance imaging (MRI) features. Methods: We retrospectively identified all inpatients with a single symptomatic MRI-confirmed RSSI between 2008 and 2013. RSSIs were rated for size, shape, location (i.e. anterior: basal ganglia and centrum semiovale posterior cerebral circulation: thalamus and pons) and MRI signs of concomitant CSVD. In a further step, clinical data, including detailed diagnostic workup and vascular risk factors, were analyzed with regard to RSSI features. Results: Among 335 RSSI patients (mean age 71.1 ± 12.1 years), 131 (39%) RSSIs were >15 mm in axial diameter and 66 (20%) were tubular shaped. Atrial fibrillation (AF) was present in 44 (13.1%) and an ipsilateral vessel stenosis > 50% in 30 (9%) patients. Arterial hypertension and CSVD MRI markers were more frequent in patients with anterior-circulation RSSIs, whereas diabetes was more prevalent in posterior-circulation RSSIs. Larger RSSIs occurred more frequently in the basal ganglia and pons, and the latter were associated with signs of large-artery atherosclerosis. Patients with concomitant AF had no specific MRI profile. Conclusion: Our findings suggest the contribution of different pathophysiological mechanisms to the occurrence of RSSIs in the anterior and posterior cerebral circulation. While there appears to be some general association of larger infarcts in the pons with large-artery disease, we found no pattern suggestive of AF in RSSIs.

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