Posterior Cerebral Artery Stroke Workup

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

Laboratory Studies

  • Essential components of workup in posterior cerebral artery (PCA) stroke depend on the patient's age, stroke risk factors, and prior medical history.
  • Studies used to evaluate the older patient (whose stroke is associated with cardiovascular disease) may include those that assess (1) severe anemia or volume depletion that can cause, worsen, or confound cerebral ischemia, (2) early infection as a result of aspiration, and (3) baseline coagulation status in case treatment involves heparin, warfarin, or thrombolysis. Appropriate tests include the following:
    • Complete blood cell count
    • Platelet count
    • Serum electrolytes
    • Blood urea nitrogen
    • Creatinine
    • Glucose
    • Prothrombin time
    • Activated partial thromboplastin time
    • International normalized ratio
    • Urinalysis
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Imaging Studies

[1]

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Other Tests

  • Strokes occurring in persons younger than 50 years require investigation for etiologies such as cardiac defects (patent foramen ovale), thrombophilia or hypercoagulable state (protein S or C or antithrombin III deficiency, activated protein C resistance, G20210A prothrombin mutation), arterial dissection, connective-tissue autoimmune disorders (antiphospholipid syndrome), and malignancy.
  • Identification of other stroke risk factors, including hypertension, diabetes, elevated cholesterol and lipid panels, and hyperhomocysteinemia, is also useful.
  • Some authorities have expressed concern that chiropractic manipulation of the neck may cause vertebral artery dissection.
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Procedures

  • Intravenous tissue plasminogen activator (tPA) may be given to patients who present within 3 hours of developing a disabling ischemic stroke. Because of the increased risk for complicating intracerebral hemorrhage, there are rigid guidelines for administering tissue plasminogen activator.
  • In 2009, the American Heart Association/American Stroke Association (AHA/ASA) published a science advisory recommending that the time window for tPA administration be increased to 4.5 hours after a stroke, although this change has not been approved by the FDA.[14] Research indicates that tPA is effective in patients even when administered within the 3- to 4.5-hour window,[15, 16, 17] but the AHA/ASA stated that, despite its recommendation, the effectiveness of tPA administration in comparison with other treatments for thrombosis, within that time period, is not yet known.
  • The eligibility criteria for treatment between 3 and 4.5 hours are similar to those employed for treatment prior to 3 hours, as established in the AHA/ASA's 2007 guidelines,[18] but with the exclusion criteria expanded to include any of the following patient characteristics:
    • Age greater than 80 years
    • Use of oral anticoagulants
    • Baseline National Institutes of Health (NIH) Stroke Scale score >25
    • A history of both stroke and diabetes
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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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