Posterior Circulation Strokes

 

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