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.