(Stroke. 2000;31:2011.)
© 2000 American Heart Association, Inc.
Special Report |
Posterior Circulation Ischemia: Then, Now, and Tomorrow
The Thomas Willis Lecture—2000
Presented as the Thomas Willis Lecture at the American Heart Association 25th International Stroke Conference, New Orleans, La, February 10, 2000.
From the Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Mass.
Correspondence to Louis Caplan, MD, Department of Neurology, Dana 779, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215. E-mail lcaplan@caregroup.harvard.edu
Key Words: basilar artery • cerebral embolism • cerebral infarction • vertebral artery • vertebrobasilar circulation
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Introduction |
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To know and appreciate where we are now and where we are going in the future, it is essential to know where we have been. We cannot afford to relive and repeat the history of stroke every several decades. Posterior circulation stroke represents a microcosm of stroke in general. In this presentation I first review the development of ideas regarding brain and posterior circulation ischemia and its recognition and treatment. I then share some recent data from a large prospective registry of patients with posterior circulation ischemia. Finally, I look ahead to reflect on what I believe should be the future directions for research and for the care of patients with posterior circulation disease.
Patients who present to physicians and hospitals with symptoms that
suggest posterior circulation ischemia are handled differently
from patients who have symptoms that suggest anterior circulation
disease in the great majority of medical facilities in the United
States and in the world. A patient who has an attack of dizziness with
diplopia and ataxic gait usually has a brain image but seldom has
vascular or cardiac investigations. A diagnosis of "vertebrobasilar
insufficiency" (VBI) is often made, and physicians then debate
whether or not to treat with warfarin-type anticoagulants, and, if so,
for how long and at what intensity. In contrast, a patient who has
right-hand weakness and aphasia is usually evaluated and treated quite
differently at the very same facilities. Brain imaging, cardiac
investigations, noninvasive vascular tests of the carotid and
intracranial anterior circulation with the
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