The following is a summary of “Pearls for the Emergency Clinician: Posterior Circulation Stroke,” published in the November 2023 issue of Emergency Medicine by Pelletier, et al.

Posterior circulation (PC) stroke in people is a dangerous disease that is rarely identified and has a high death rate. For a study, researchers sought to look at how PC strokes show up, how they are diagnosed, and how they are treated in the emergency room (ED). PC stroke usually shows up as dizziness or vertigo, and it needs to be told apart from other, less severe conditions. Emergency room doctors should look into this condition in dizzy people, even if they are younger or don’t have other standard risk factors for stroke. 

A neurological test is needed for specific neurologic impairments, dysmetria, dysarthria, and truncal ataxia. It is also important to tell the difference between acute vestibular syndrome, spontaneous episodic vestibular syndrome, and triggered episodic vestibular syndrome. When done by someone with the right training, the HINTS (head impulse, nystagmus, and test of skew) examination can help find dizziness signs that could be signs of a stroke. 

However, it should only be given to people who are constantly dizzy and have nystagmus. CT scans like contrast tomography (CT), CT angiography, and CT perfusion are not very good at finding PC strokes. Magnetic resonance imaging is the best, but may miss some PC strokes early on. Thrombolysis was suggested for patients who appear within the right time for thrombolytic treatment. Some data show that endovascular therapy for basilar artery and posterior cerebral artery infarcts is helpful, but it has yet to be proven to be useful for all PC strokes. Emergency room doctors can better diagnose and treat PC strokes if they know more about them.

Source: sciencedirect.com/science/article/abs/pii/S0736467923004006