Recognition of posterior circulation stroke

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.