Diagnostic Considerations
The usual differential diagnosis for posterior cerebral artery (PCA) stroke includes other vascular diseases such as intracerebral hemorrhage, cerebral venous infarction, subarachnoid hemorrhage, and subdural hemorrhage. Rarely, space-occupying lesions (eg, glioma) present as sudden onset of deficit.
Demyelinating lesions (eg, multiple sclerosis) rarely present as hemianopia, but this does occur in a few patients. Posterior reversible encephalopathy syndrome may present with visual disturbances and imaging abnormalities within the occipital lobes.
Conditions to consider in the differential diagnosis of PCA stroke include the following:
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Basilar artery thrombosis
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Cardioembolic stroke
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Dissection syndromes
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Intracranial hemorrhage
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Mitochondrial encephalomyopathy, lactic acidosis, strokelike episodes (MELAS)
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Multiple sclerosis
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Brain metastases
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Trauma
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Infection
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Cardiac embolism
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Brainstem infarction
Differential Diagnoses
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Posterior reversible encephalopathy syndrome
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Unenhanced head computed tomography (CT) scan demonstrating a subacute L posterior cerebral artery (PCA) infarct.
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Unenhanced head computed tomography (CT) scan demonstrating hemorrhagic conversion of an ischemic stroke, approximately 72 hours after symptom onset.
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Brain magnetic resonance imaging (MRI) scan demonstrating acute stroke. Diffusion restriction is seen on diffusion-weighted imaging.
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Magnetic resonance (MR) angiogram demonstrating bilateral fetal posterior cerebral artery (PCA) variants (black arrows) with the basilar artery terminating in bilateral superior cerebellar arteries (blue arrows).
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Digital subtraction angiogram demonstrating an acute L posterior cerebral artery (PCA) occlusion (red arrow) following balloon-assisted coiling of a basilar tip aneurysm.
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Digital subtraction angiogram demonstrating revascularization of acute L posterior cerebral artery (PCA) occlusion (red arrow) during a balloon-assisted basilar tip aneurysm revascularization with use of balloon angioplasty.
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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 (PCA) ischemic infarct.