Posterior Circulation Ischemic Strokes

Last week we had the opportunity to learn about posterior circulation ischemic strokes from vascular neurologist, Dr. Osteraas.

Diagnosing posterior circulation ischemic strokes can be challenging in the emergency department, largely because posterior circulation ischemic strokes frequently lack “traditional” stroke signs and symptoms and the symptoms that you do see are often non-specific and can be slow onset. Despite this, it is important to do our best to diagnose these as about 20% of ischemic events involve the posterior circulation and posterior circulation ischemic strokes can lead to some of the most devastating neurologic outcomes, including massive cerebellar infarcts with subsequent herniation and locked in syndrome.

Posterior Reversible Encephalopathy Syndrome (PRES)

At last month’s mortality and morbidity conference, we discussed a case of Posterior Reversible Encephalopathy Syndrome (PRES). Our consultant, a neuro-intensivist, told us that PRES is not always posterior, not always reversible nor always presenting with encephalopathy. Thanks whoever named that syndrome. The presentation is extremely variable. Typically presenting with: headache, altered mental status, visual