Posterior Cerebral Artery Stroke Follow-up

  • Author: Christopher Luzzio, MD; Chief Editor: Denise I Campagnolo, MD, MS   more...
 
Updated: Jan 18, 2012
 

Further Inpatient Care

  • Patients with acute posterior cerebral artery (PCA) infarcts generally are hospitalized, unless, due to late diagnosis, they can be seen safely on an outpatient basis. Aggressive rehabilitation begins once the patient is medically stable. Goals include maintaining range of motion, promoting active movement of the hemiplegic side if applicable, improving the patient's functional mobility and self-care capabilities, and monitoring medical conditions affecting recovery and prevention of further disability,
Next

Further Outpatient Care

  • Depending on the degree of motor loss, available insurance coverage, and other variables, such as social situation, the patient may qualify for continued outpatient or home therapy.
  • The patient with posterior cerebral artery (PCA) stroke may want to drive or participate in activities dangerous to a person with homonymous hemianopsia vision loss. Some recovery of vision may occur. Repeated visual-field testing is required, as well as further assessment by occupational therapists and clinicians.
Previous
Next

Inpatient & Outpatient Medications

  • Discharge medications may include specific agents for stroke prevention (eg, aspirin, clopidogrel, warfarin) that usually are recommended by the neurologist prior to transfer to a neurorehabilitation setting. Cholesterol-lowering drugs, antihypertensive therapies, muscle relaxants, and substances for treating rare thalamic pain or chronic headaches or depression may be prescribed.
Previous
Next

Complications

  • Complications that may occur in the patient with posterior cerebral artery (PCA) stroke are described in other sections. See Medical Issues/Complications and Medical/Legal Pitfalls.
Previous
Next

Prognosis

  • On average, patients with posterior cerebral artery (PCA) stroke sustain minimal or no chronic motor disability. These patients are usually able to adapt to their visual deficit so that many ADL tasks are manageable.
  • Of young stroke victims, 30-70% return to work, with the higher fraction being men and those educated beyond high school.
  • In a single-blind cluster, randomized, controlled trial, stroke patients in acute stroke units (ASUs) were evaluated 90 days after hospital admission. ASUs were randomly appointed to intervention (n=10) or control (n=9). Those patients who received a multidisciplinary intervention focusing on evidence-based management of fever, hyperglycemia, and swallowing dysfunction were much less likely to be dead or dependent at 90 days, despite the severity of the stroke, compared with the control ASU patients.[23]
Previous
Next

Patient Education

  • The patient must learn conscious scanning into the visual-field deficit. The hemiparetic patient who has sustained a posterior cerebral artery (PCA) stroke must learn transfer techniques, walking with mechanical assistance (if feasible), and modified ADL (eg, dressing, bathing, cooking). Some patients require a significant amount of assistance. The patient's caregiver should meet with therapists to learn how best to help the patient at home without causing personal or other injury.
  • For patient education resources, see the Stroke Center, as well as Stroke.
Previous
 
Contributor Information and Disclosures
Author

Christopher Luzzio, MD  Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison School of Medicine and Public Health

Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Coauthor(s)

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Elizabeth A Moberg-Wolff, MD  Medical Director, Pediatric Rehabilitation Medicine Associates

Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation

Disclosure: Medtronic Neurological None Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard Salcido, MD  Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS  Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers

Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers

Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching; Genzyme Corporation Grant/research funds investigator; Biogen Idec Grant/research funds investigator; Genentech, Inc Grant/research funds investigator; Eli Lilly & Company Grant/research funds investigator; Novartis investigator; MSDx LLC Grant/research funds investigator; BioMS Technology Corp Grant/research funds investigator; Avanir Pharmaceuticals Grant/research funds investigator

References

  1. Kapoor K, Singh B, Dewan LI. Variations in the configuration of the circle of Willis. Anat Sci Int. Jun 2008;83(2):96-106. [Medline].

  2. Arboix A, Arbe G, García-Eroles L, Oliveres M, Parra O, Massons J. Infarctions in the vascular territory of the posterior cerebral artery: clinical features in 232 patients. BMC Res Notes. Sep 7 2011;4:329. [Medline]. [Full Text].

  3. Kwon JY, Kwon SU, Kang DW, Suh DC, Kim JS. Isolated lateral thalamic infarction: the role of posterior cerebral artery disease. Eur J Neurol. Aug 5 2011;[Medline].

  4. Brandt T, Steinke W, Thie A. Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome (1). The authors dedicate this paper to Michael S Pessin, MD, who died before publication. Multicenter results and a review of the literature. In: Cerebrovasc Dis. May-Jun 2000;10(3):170-82. [Medline].

  5. Devinsky O, Bear D, Volpe BT. Confusional states following posterior cerebral artery infarction. Arch Neurol. Feb 1988;45(2):160-3. [Medline].

  6. Capitani E, Laiacona M, Pagani R, et al. Posterior cerebral artery infarcts and semantic category dissociations: a study of 28 patients. Brain. Mar 2 2009;[Medline].

  7. Barbeau H, Norman K, Fung J. Does neurorehabilitation play a role in the recovery of walking in neurological populations?. Ann N Y Acad Sci. Nov 16 1998;860:377-92. [Medline].

  8. Steinke W, Mangold J, Schwartz A. Mechanisms of infarction in the superficial posterior cerebral artery territory. J Neurol. Sep 1997;244(9):571-8. [Medline].

  9. de Monye C, Dippel DW, Siepman TA, et al. Is a fetal origin of the posterior cerebral artery a risk factor for TIA or ischemic stroke? A study with 16-multidetector-row CT angiography. J Neurol. Feb 2008;255(2):239-45. [Medline].

  10. Hasso AN, Stringer WA, Brown KD. Cerebral ischemia and infarction. Neuroimaging Clin N Am. Nov 1994;4(4):733-52. [Medline].

  11. Sylaja PN, Puetz V, Dzialowski I, et al. Prognostic value of CT angiography in patients with suspected vertebrobasilar ischemia. J Neuroimaging. Jan 2008;18(1):46-9. [Medline].

  12. Finelli PF. Neuroimaging in acute posterior cerebral artery infarction. Neurologist. May 2008;14(3):170-80. [Medline].

  13. Kwak JH, Choi JW, Park HJ, Chae EY, Park ES, Lee DH, et al. Cerebral artery dissection: spectrum of clinical presentations related to angiographic findings. Neurointervention. Aug 2011;6(2):78-83. [Medline]. [Full Text].

  14. Del Zoppo GJ, Saver JL, Jauch EC, et al. Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator. A science advisory from the American Heart Association/American Stroke Association. Stroke. May 28 2009;[Medline]. [Full Text].

  15. Rothwell PM. Is intravenous recombinant plasminogen activator effective up to 4.5 h after onset of ischemic stroke?. Nat Clin Pract Cardiovasc Med. Mar 2009;6(3):164-5. [Medline].

  16. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. Sep 25 2008;359(13):1317-29. [Medline]. [Full Text].

  17. Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase 3-4.5 h after acute ischaemic stroke (SITS-ISTR): an observational study. Lancet. Oct 11 2008;372(9646):1303-9. [Medline].

  18. Adams HP Jr, del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. May 2007;38(5):1655-711. [Medline]. [Full Text].

  19. Adams DS. Stroke rehabilitation: indications, outcomes, recent developments. J La State Med Soc. Nov 1996;148(11):498-502. [Medline].

  20. Hanlon RE, Dobkin BH, Hadler B. Neurorehabilitation following right thalamic infarct: effects of cognitive retraining on functional performance. J Clin Exp Neuropsychol. Jul 1992;14(4):433-47. [Medline].

  21. Hassid EI. Neuropharmacological therapy and motor recovery after stroke. Mil Med. May 1995;160(5):223-6.

  22. Rose FD, Brooks BM, Attree EA. A preliminary investigation into the use of virtual environments in memory retraining after vascular brain injury: indications for future strategy?. Disabil Rehabil. Dec 1999;21(12):548-54. [Medline].

  23. Middleton S, McElduff P, Ward J, et al. Implementation of evidence-based treatment protocols to manage fever, hyperglycaemia, and swallowing dysfunction in acute stroke (QASC): a cluster randomised controlled trial. Lancet. Nov 12 2011;378(9804):1699-706. [Medline].

  24. Gustafsson D, Elg M. The pharmacodynamics and pharmacokinetics of the oral direct thrombin inhibitor ximelagatran and its active metabolite melagatran: a mini-review. Thromb Res. Jul 15 2003;109 Suppl 1:S9-15. [Medline].

  25. Georgiadis AL, Yamamoto Y, Kwan ES. Anatomy of sensory findings in patients with posterior cerebral artery territory infarction. Arch Neurol. Jul 1999;56(7):835-8. [Medline]. [Full Text].

  26. Ghika J, Bogousslavsky J, Henderson J. The "jerky dystonic unsteady hand": a delayed motor syndrome in posterior thalamic infarctions. J Neurol. Aug 1994;241(9):537-42. [Medline].

  27. Takenouchi T, Shimozato S, Fujiwara H, Momoshima S, Takahashi T. Posterior cerebral artery dissection on a serial magnetic resonance angiography. Brain Dev. Jul 16 2011;[Medline].

  28. Traversa R, Cicinelli P, Bassi A. Mapping of motor cortical reorganization after stroke. A brain stimulation study with focal magnetic pulses. Stroke. Jan 1997;28(1):110-7. [Medline].

  29. Volpe BT, Krebs HI, Hogan N. Robot training enhanced motor outcome in patients with stroke maintained over 3 years. Neurology. Nov 10 1999;53(8):1874-6. [Medline].

  30. Yamamoto Y, Georgiadis AL, Chang HM. Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry. Arch Neurol. Jul 1999;56(7):824-32. [Medline]. [Full Text].

  31. Zweifler RM. Management of acute stroke. South Med J. Apr 2003;96(4):380-5. [Medline].

 
Previous
Next
 
Computed tomography (CT) scan of the brain showing hypodense areas in the right occipital lobe consistent with a recent posterior cerebral artery ischemic infarct.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.