Background:
- Up to 20% of CVAs involve posterior circulation
- Most commonly missed
- Posterior strokes not well identified on the usual screening tools
Anatomy:
Symtoms:
- dizziness
- off balance
- sensation vision is blurry, oscillating or jumping
- bilateral leg weakness and / or numbness
- hemiparesis with motion disturbances on non-hemiparetic side
- facial symptoms
Signs:
- ataxia (finger to nose / heel to shin / truncal)
- ataxia when standing (Romberg) or walking
- locked-in syndrome
- nystagmus
- bilateral horizontal gaze palsy
- internuclear ophthalmoplegia:
- vertical and rotatory nystagmus
- visual field defects
Vertebral Artery Dissection:
- sudden rotational force
- minor trauma, childbirth, sexual intercourse, coughing, sneezing, Chiropractic high velocity manipulation
- 60%-90% also complain of headache and / or neck pain
Detection:
We can take the F.A.S.T. assessment tool and expand it to B.E. F.A.S.T. to help improve detection of posterior circulation stroke. This link is a short video explaining the components of the B.E. F.A.S.T. screening tool.
Take Home Messages:
- consider stroke with any sudden onset neurologic symptoms
- maintain high index of suspicion for posterior circulation strokes
- check balance, ambulation, extraocular movements and vision
- consider with patients who complain of dizziness
where did you obtain this information for the posterior stroke?
I use a variety of sources for the podcast material including journal articles and other publications, for example UpToDate and emedicine.com.