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In a prospective study of 70 patients with infarcts in the posterior circulation admitted consecutively to a population-based primary-care center,we assessed infarct location and etiology using magnetic resonance imaging,three-dimensional time-of-flight magnetic resonance angiography, and noninvasive cardiac tests.The brainstem(mainly the paramedian pons)was the most commonly infarcted site(41/70,59%),followed by the cerebellum(33/ 70,47%).Combined supra-and infratentorial multiple vertebrobasilar infarcts occurred in 11 patients(16%).Overall,27 patients(39%)had>/=50% stenosis or occlusion of the basilar artery.There were other large-artery lesions in 19 patients(27%),including vertebral(V2-V4)stenosis or occlusion(in seven)and dolichoectatic vertebral/basilar arteries(in 12). Fifteen of the 70 patients had a potential cardiac source of embolism, which coexisted with large-artery disease in more than one-third of the cases.Cerebellar infarct without concomitant brainstem or occipital infarct was associated with cardioembolism(67%),while isolated paramedian pontine or midbrain infarct was associated with basilar artery stenosis (71%),suggesting in situ occlusion of the mouth of the perforators off the stenosed basilar artery.After exclusion of other potential causes of stroke,presumed small-artery disease associated with chronic hypertension remained the likely etiology in only 11 patients(16%),but these infarcts were not associated with any of the classical lacunar syndromes.Our findings emphasize the high frequency of severe intracranial large-artery disease is posterior circulation infarcts. |
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basilar artery occlusion
basilar artery stenosis
brainstem,infarction of
cerebellar infarction
cerebrovascular accident
cerebrovascular accident,etiology
cerebrovascular accident,vascular territory involved
MRI
MRI,abnormal
MRI,angiography
occipital lobe,infarction
posterior cerebral artery territory infarction
vertebral artery stenosis
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