Stroke in the rear circulation: Symptoms, remedies, and prognosis
Posterior circulation (PC) strokes, while making up around 20-25% of all ischemic strokes, are less likely to cause significant disability or death compared to other types of strokes. However, they can still lead to extensive hospitalization or disability, and their unique symptoms require specific attention.
Strokes are medical emergencies that can cause death or significant disability. Early treatment is crucial as it could save a person's life and reduce brain damage from a stroke. PC strokes can deprive large areas of the brain of oxygen, leading to widespread brain damage.
The outlook for people who experience a PC stroke is generally better, but it's essential to be aware of the symptoms and seek immediate medical help. The "5 D's" of PC strokes, a clinical mnemonic, can help in recognising key symptoms associated with ischemia in the posterior circulation of the brain. These symptoms include:
- Dizziness (vertigo or disequilibrium)
- Diplopia (double vision)
- Dysarthria (slurred or impaired speech)
- Dysphagia (difficulty swallowing)
- Drop attacks (sudden falls without loss of consciousness)
These symptoms reflect brainstem and cerebellar dysfunction often involved in posterior circulation strokes. If you or someone else experiences these symptoms, it's crucial to immediately call 911 or go to the nearest emergency room.
Many conditions can lead to strokes, with some of the more common causes of PC strokes being atherosclerosis, cardioembolisms, and artery rupture. Less commonly, PC strokes can be caused by vasculitis, fibromuscular dysplasia, blood clotting disorders, drug use, and migraine.
Diagnosis of PC strokes involves imaging studies such as CT angiography, digital subtraction angiography (DSA), and MRI scans. The first phase of PC stroke treatment focuses on preventing brain damage, saving the person's life, and limiting disability. Treatment options during this phase may include intravenous tissue plasminogen activator medications, surgery to remove blood clots, or surgery to widen narrowed arteries.
The second phase of PC stroke treatment focuses on preventing further strokes. This may involve taking medications like antiplatelet or anticoagulation drugs, and lifestyle strategies such as diet and exercise. If a stroke causes long-term disability, rehabilitation may be required, which could take several months.
It's important to note that some stroke risk factors are modifiable. People can reduce their risk of stroke by not smoking, avoiding or limiting alcohol, getting regular exercise, eating a nutrient-dense diet, managing blood pressure, managing atrial fibrillation (AFib), if applicable, and managing diabetes, if applicable.
Despite the progress in recognising and treating PC strokes, doctors are three times likelier not to recognise a PC stroke than other strokes. An initiative called the "5 D's" of PC strokes has been raised to help medical staff recognise the signs of this condition, emphasising the importance of early diagnosis and treatment.
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