This Article Full Text Correction (v28,p466) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Argentino, C. Articles by Bozzao, L. Search for Related Content PubMed PubMed Citation Articles by Argentino, C. Articles by Bozzao, L.

(Stroke. 1996;27:1306-1309.)
© 1996 American Heart Association, Inc.

Articles

Posterior Circulation Infarcts Simulating Anterior Circulation Stroke

Perspective of the Acute Phase

Corrado Argentino, MD; Manuela De Michele, MD; Marco Fiorelli, MD, PhD; Danilo Toni, MD, PhD; Maria Luisa Sacchetti, MD; Cristina Cavalletti, MD; Giuliano Sette, MD; Anne Falcou, MD; Stefano Bastianello, MD, PhD Luigi Bozzao, MD

the Department of Neurological Sciences, University "La Sapienza," Rome, Italy.

Background and Purpose Ischemic stroke patients whose initial clinical presentation suggests an involvement of the anterior circulation (AC) are sometimes found to have a posterior circulation (PC) infarct, a fact that may generate erroneous decisions in clinical management. We investigated the prevalence of this misdiagnosis in the first few hours after stroke onset.

Methods We performed a cohort study of 158 patients hospitalized within 5 hours of onset of a presumed AC ischemic stroke, as diagnosed on clinical grounds.

Results Final CT or pathology diagnosis was AC infarct in 128 patients (81%), a repeatedly negative CT in 14 (9%), PC infarct (5 pons, 1 midbrain and cerebellum, 6 supratentorial territory of the posterior cerebral artery) in 12 (8%), and other or undiagnosed lesions in 4 (3%). AC and PC stroke patients did not differ in terms of age, vascular risk factors, and initial severity, but the latter were more frequently men (83% versus 53%; P=.04), were hospitalized later (mean±SD, 168±86 versus 109±55 minutes; P=.001), and presented a pure motor hemiparesis or a sensorimotor stroke (50% versus 33%) more often than their counterparts. At baseline CT, PC stroke patients never exhibited an early parenchymal hypodensity in the carotid territory or a hyperdense middle cerebral artery, which were instead found in 59% (P=.0003) and 31% (P=.02) of AC stroke patients, respectively. Early neurological deterioration, 1 month case-fatality rate, and disablement in survivors were comparable in the two groups.

Conclusions Shortly after onset the clinical discrimination between AC and nontypical PC infarcts is not reliable, which explains the frequent occurrence of this misdiagnosis. Emergency CT scan helps in the differential diagnosis only when it demonstrates an early focal hypodensity within the carotid territory.

Key Words: cerebral ischemia • diagnosis • stroke assessment • vertebrobasilar circulation

This article has been cited by other articles:

				Skutta, Fürst, Eilers, Ferbert, and Kuhn Intracranial Stenoocclusive Disease: Double-Detector Helical CT Angiography versus Digital Subtraction AJNR Am. J. Neuroradiol., May 1, 1999; 20(5): 791 - 799. [Abstract] [Full Text]

				Corrections Stroke, February 1, 1997; 28(2): 466 - 466. [Full Text]