Clinical and radio imaging study in posterior circulation stroke

Background Posterior circulation stroke (PCS), involving the vertebrobasilar system, accounts for nearly 20% of all ischemic strokes. Unlike anterior strokes, PCS often presents with non-specific symptoms such as dizziness, vomiting, and visual field defects, leading to frequent misdiagnosis and delayed treatment. Given its distinct vascular anatomy and symptomatology, comprehensive evaluation using both clinical and radiological parameters is essential for early detection and appropriate management.

Objectives To study the various clinical patterns and risk factors associated with posterior circulation stroke in patients presenting to a tertiary care hospital.

Methods A cross-sectional prospective study was conducted over 18 months at Al-Ameen Medical College Hospital, Vijayapur, involving 100 patients diagnosed with posterior circulation stroke. Data were collected through structured clinical evaluations, laboratory investigations, and neuroimaging. MRI and MRA were utilized to confirm the diagnosis and localize vascular involvement. Clinical variables such as symptoms, risk factors, and arterial territories involved were statistically analyzed using SPSS version 26.

Results The mean age of the patients was 55.22 ± 12.35 years, with a male predominance (63%). The most prevalent risk factor was hypertension (61%), followed by smoking (27%), dyslipidemia (24%), alcohol use (23%), and diabetes mellitus (18%). The most frequent clinical manifestations were giddiness and vomiting (58%), motor weakness (47%), cranial nerve involvement (38%), cerebellar signs (28%), and visual field defects (24%). Radiologically, the posterior cerebral artery (47%) and posterior inferior cerebellar artery (45%) were the most commonly affected vascular territories. Other significant arteries included the superior cerebellar artery (20%) and basilar artery (17%).

Conclusion Posterior circulation stroke predominantly affects males over the age of 50 and is strongly associated with hypertension and smoking. Clinical presentations are variable and often non-specific, necessitating high clinical suspicion. MRI-based imaging plays a critical role in diagnosis. Early identification and targeted interventions based on vascular territory involvement and associated risk factors can significantly improve outcomes.