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Recognition of posterior circulation stroke
Author(s) -
Puustjärvi V.,
Strbian D.,
Tiainen M.,
Curtze S.,
Tatlisumak T.,
Sairanen T.
Publication year - 2015
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12351
Subject(s) - medicine , stroke (engine) , thrombolysis , atrial fibrillation , dyslipidemia , anesthesia , warfarin , vomiting , cardiology , mechanical engineering , myocardial infarction , engineering , obesity
Objectives Better identification and triage of acute posterior circulation ( PC ) stroke patients is needed as the PC ischemic stroke ( IS ) patients may be allowed longer thrombolysis window than anterior circulation ( AC ) IS patients and PC patients with hemorrhagic stroke ( ICH ) may require care in a neurosurgical unit possibly remote from stroke unit. Materials and methods Consecutive stroke patients treated at a tertiary center with thrombolysis (100% for IS ) and/or comprehensive stroke unit care. Results Altogether, 1641 patients had AC (75%) and 553 PC strokes. The PC ‐ IS patients were younger (65 vs 70), had less often prior hypertension (51 vs 61%), and were twice more often on warfarin. They presented 3.5 times more often with seizure, vomited five times more often, had headache twice as often, and required intubation 2 to 3 times more often despite equal NIHSS (9 vs 8) or GCS (15 both) scores with AC ‐ IS patients. Among PC patients, IS (n = 190) associated with younger age, prior atrial fibrillation ( AF ) in 25% and dyslipidemia in ~40%. One‐third of PC ‐ ICH patients (n = 363) had headache and vomited at the onset. PC ‐ ICH patients had BP median of 177/92 mmHg and blood glucose 7.4 mmol/l on ER arrival. Warfarin use was twice as common in PC ‐ ICH . Conclusions Despite being of typical age for multiple cardiovascular conditions the PC ‐ ICH patients less often have a previous history of AF or dyslipidemia than IS patients do. The vomiting PC ‐ ICH patient with hypertensive BP values often has headache and a red flag for hemorrhage is warfarin treatment.