Next we'll tackle lasting damage due to cessation of blood flow due to blockage of a vessel this severe, prolonged ischemia leads to "infarction." Last we'll investigate another type of severe ischemia: hermorrhage. First we'll discuss the largely reversible damage that can occur following transient ischemia - a reduction in adequate flow of blood to tissue. 2018 9(1):580.While the previous section covered the vasculature that supplies oxygenated blood to the structures of balance, this section looks at the consequences that arise when that flow of blood is impaired. Clinical outcome of isolated cerebellar stroke – a prospective observational study. Nickel A, Cheng B, Pinnschmidt H, Arpa E, Ganos C et al. Acute obstructive hydrocephalus caused by cerebellar infarction: treatment alternatives. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study.
Schonewille WJ, Wijman CA, Michel P, Rueckert CM, Weimar C, Mattle HP, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, et al. Intracranial vascular stenosis and occlusive disease: evaluation with CT angiography, MR angiography, and digital subtraction angiography. Bash S, Villablanca JP, Jahan R, Duckwiler G, Tillis M, Kidwell C, et al. Symptoms and signs of posterior circulation ischemia in the New England Medical Centre posterior circulation registry. Searls DE, Pazdera L, Korbel E, Vysata O, Caplan LR. Posterior circulation ischemia: then, now, and tomorrow. New England Medical Center posterior circulation registry. Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, et al. Differential diagnosisĭue to the small confined area in the inferior aspect of the posterior cranial fossa, the swelling caused by a PICA infarct can lead to significant mass effect and midline shift which may mimic a cerebellar mass such as a primary brain tumor or metastasis. In large volume cerebellar infarcts, neurosurgical treatment with occipital decompression or external ventricular drainage (EVD) can be lifesaving in patients who have acute hydrocephalus or raised intracranial pressure causing reduces consciousness 11. In PICA infarction, the outcomes are generally expected to be good 12. If the timing of diagnosis fits within 4.5 hours of the onset of symptoms, then patients can be treated with thrombolysis 9. Acute endovascular therapies, often in the form of lysis or clot removal, can be used, particularly in basilar artery occlusion 10. Treatment of posterior inferior cerebellar artery, and posterior circulation strokes in general, depends upon the nature, timing, and severity of symptoms. In the first twenty-four hours, studies show approximately 75-95% sensitivity for MRI diffusion-weighted images, compared to CT of 16% 8.
MRI is far superior to CT in the sensitivity of acute ischemic stroke across all vascular territories. MR angiography and CT angiography both have very high sensitivity for vessel occlusion identification, at 87% and 100% respectively 7. CT angiography should be utilized if the patient fits thrombolysis therapy guidelines 6. Variations are common and the PICA syndrome for example, often presents with facial pain as the initial symptom and hypoalgesia, affecting either side of face 5.Īs with all cases of suspected stroke, CT or MRI is required urgently to exclude hemorrhagic stroke. There are multiple eponymous posterior stroke syndromes, often presenting incompletely 4.
#Pica syndrome stroke full#
Headache and neck pain is normally the result of full posterior inferior cerebellar artery territory infarcts and is likely secondary to the associated swelling and mass effect 3. Signs of a lateral medullary syndrome may coexist in ~30% 2. Vertigo, nausea and truncal ataxia are the most common presenting features. Typically considered the most common territory involved in cerebellar infarction, although at least one study 1 has demonstrated similar frequencies of PICA and superior cerebellar artery (SCA) infarcts.
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