A STUDY OF 82 CASES OF POSTERIOR CEREBRAL -ARTERY TERRITORY INFARCTION

Of 598 consecutive non-selected cases of cerebral infarction included in a stroke registry, 82 cases (54 men and 28 women, mean age 66 +/- 1 4 years) of spontaneous and isolated posterior cerebral artery (PCA) t erritory infarction (right PCA in 36, left PCA in 35 and both in 11) w ere identified on the basis of CT combined with MRI in 51 cases. Infar ction was superficial in 25 (group A), combined deep-superficial in 23 (group B) and deep in 34 (group C). Of 48 superficial lesions, 29 wer e massive while 19 were restricted to the territory of one branch. Of 57 deep lesions, 21 were located in the inferolateral thalamic territo ry, 10 in the paramedian thalamic territory, 12 in other midbrain or t halamic territories, and 14 in a combination of various midbrain and/o r thalamic territories. Of 41 patients with unilateral superficial inv olvement, 39 had homonymous visual field defect. Unawareness of the vi sual defect and visual release hallucinations were observed with the s ame frequency in right and left lesions. Of 7 patients with bilateral superficial involvement, only 5 had bilateral visual field defect incl uding incomplete cortical blindness in 3. The frequency of confusional state (n - 24) did not differ significantly in left versus right side d lesions while it was significantly higher in superficial or combined versus deep lesions (p - 0, 05). Of 18 clinically evaluable patients with left PCA territory infarct, 14 had speech disorders including pur e alexia in only one case. Of 15 patients with right territory infarct ion, 10 had spatial judgement disorders. Other signs included hemisens ory loss (n = 38), hemiparesis (n - 28), oculomotor disorders (n = 17) , hemiataxia (n = 10), involuntary movements (n = 4), hypovigilance (n = 15) and orbitary headaches ipsilateral to the infarct (n = 11). The causes of PCA territory infarcts (atherosclerosis n = 35; cardiogenic embolism n = 15; small vessels disease n = 13; other identified cause s n = 3, including 2 migrainous strokes ; mixed causes n = 7; undeterm ined cause n = 9) did not differ significantly from those of all cereb ral infarcts collected in our registry. Patients' functional state was evaluated using both Barthel index and Rankin scale. On admission, gr oup B did significantly worse than group C and group C did worse than group A, suggesting that the severity of stroke was correlated with de ep involvement. Six patients died acutely and the survivors were follo wed 22 +/- 12 months. Groups A and C had good recovery while groupe B had significantly poorer functional prognosis. Seven patients experien ced recurrent stroke and 8 patients died, either from stroke (2 cases) or from another cause (6 cases). Two-year actuarial survival rate was 82 +/- 6 per cent in the 82 patients; it was significantly lower in g roup B (63 +/- 21 per cent) compared with group A (95 +/- 6 per cent) because of a higher early mortality in group B.