Posterior Cerebral Artery Stroke Treatment & Management

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

Rehabilitation Program

Physical Therapy

A small percentage of patients with a posterior cerebral artery (PCA) infarct suffer chronic motor deficits. Approximately 5% of patients who do may require transfer, gait, and stair training with an assistive device. Orthotic devices (eg, ankle-foot orthosis) also may be beneficial. Patients with PCA infarcts may demonstrate delayed postural reactions due to sensorimotor deficits. Programs designed to improve postural control and balance may be helpful. Home exercise programs and family/caregiver training are important to sustaining improvement after discharge from therapy.[19]

Occupational Therapy

The occupational therapist helps the patient adapt to homonymous hemianopia and visual-spatial function abnormalities. The patient benefits from scanning into the field deficit. A small percentage of patients who have suffered a posterior cerebral artery (PCA) stroke require therapy for motor deficits of the upper limb.

Speech Therapy

Speech therapy usually is not required for patients who have had a posterior cerebral artery (PCA) stroke. However, in infrequent cases in which there is neuropsychologic deterioration or memory-language deficits,[6] a speech therapist should be consulted. Although dysphagia typically is not associated with PCA infarcts, evaluation of swallowing may be useful in patients who may be at risk for aspiration.

Recreational Therapy

Recreational therapy helps patients with posterior cerebral artery (PCA) stroke to adapt to visual deficits and facilitates a healthy affect (since depression is a common occurrence in stroke patients).

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Medical Issues/Complications

  • Recurrent ischemic event[19]
  • Hemorrhage into infarcted brain tissue
  • Stroke-associated epilepsy
  • Anticoagulation-associated intracranial, gastrointestinal, or retroperitoneal hemorrhaging
  • Urinary tract and pulmonary infections
  • Skin breakdown
  • Depression
  • Chronic pain
  • Dyskinesia and dystonia
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Consultations

  • Ophthalmologists accurately plot visual-field loss in patients with posterior cerebral artery (PCA) stroke and can recommend corrective lenses and compensation techniques.
  • Pain specialists treat rare intractable thalamic pain with many methods including anticonvulsants (carbamazepine [Tegretol], gabapentin [Neurontin]) and tricyclic medications (amitriptyline [Elavil]). Recently, topiramate (Topamax) has been found helpful in treating headache and painful dysesthesias.
  • A psychiatrist may assist with treatment of mood disorders and psychotic symptoms.
  • A neuropsychologist can help to assess and document cognitive function, which is especially important for persons returning to professional duties, considering living alone, or applying for disability.
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Other Treatment

Many experimental treatment modalities such as cognitive retraining,[20] neuropharmacologic therapy (amphetamines),[21] robot-assisted physical and occupational therapy, and virtual environments[22] are reported to aid stroke recovery, but further evidence is needed to confirm their benefit.

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]

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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

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Computed tomography (CT) scan of the brain showing hypodense areas in the right occipital lobe consistent with a recent posterior cerebral artery ischemic infarct.
 
 
 
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