Posterior Cerebral Artery Stroke Medication

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

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Several new oral anticoagulant medications, including ximelagatran,[24] are in the final stages of clinical trials for use in the prophylaxis of ischemic thromboembolic stroke. Once approved for use, the potential of such drugs in the arena of stroke treatment is significant.

Next

Hematological agents

Class Summary

Patients entering the rehabilitation phase of their hospital course may be prescribed warfarin, clopidogrel, or aspirin. The selection of these agents is dependent on the etiology of the posterior cerebral artery (PCA) stroke, associated complications, comorbidities, and prior medical history. These medications are used to prevent further cerebral vascular ischemic events.

View full drug information

Warfarin (Coumadin)

 

Interferes with hepatic synthesis of vitamin K-dependent coagulation factors. Used for prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders.

Tailor dose to maintain an INR in the range of 2 to 3. Patients with prosthetic cardiac valves may require higher INR levels.

View full drug information

Clopidogrel (Plavix)

 

Selectively inhibits adenosine diphosphate (ADP) binding to platelet receptor and subsequent ADP-mediated activation of glycoprotein GPIIb/IIIa complex, thereby inhibiting platelet aggregation.

View full drug information

Aspirin (Anacin, Bayer Aspirin)

 

Treats mild to moderate pain and headache. Inhibits prostaglandin synthesis, which prevents formation of platelet-aggregating thromboxane A2.

Previous
Proceed to Follow-up
 
 
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.