Posterior cerebral artery territory infarcts: Clinical features, infarct topography, causes and outcome - Multicenter results and a review of the literature

Only a few large series of posterior cerebral artery (PCA) stroke exist, an d clinical features and causes have not been studied as extensively as in o ther vascular territories. The PCA syndrome includes more clinical signs th an the well-known visual field deficits. Concomitant findings are frequentl y sensory, slight motor and neuropsychological deficits. Unilateral headach es are the common presenting symptom making complicated migraine an importa nt differential diagnosis. Combined deep and superficial PCA territory infa rcts involving the lateral thalamus are more frequent than commonly assumed and are mostly associated with sensory and reversible slight motor deficit s. Occlusion of the precommunal PCA segment with associated paramedian midb rain infarction causes severe motor deficits, oculomotor signs, and decreas ed consciousness and has a poorer outcome than other PCA territory infarcts , Embolism from a cardiac or undetermined source is the leading mechanism a ccounting for up to half of the cases, whereas arterial embolism from signi ficant proximal vertebrobasilar disease is less frequent. Local atherothrom botic stenosis or occlusion of the PCA is uncommon. In spite of thorough di agnostic evaluation, the etiology of PCA territory infarction cannot be det ermined in at least one quarter of patients. Among the rare causes of PCA t erritory infarction carotid artery disease is important while the significa nce of migraine remains controversial. Copyright (C) 2000 S. Kargsr AG, Bas el.