Posterior Circulation Ischemic Stroke (Introduction)
Detection of posterior circulation ischemia begins with suspicion:
Clinical symptoms vary by the location of the infarct and size of the vessel occluded.
A detailed neurologic exam is critical in the evaluation for potential PCS.
Neuroimaging is essential in evaluating for PCS and treatment considerations
Benign causes of vertigo include
Clinical red flags
Summary of Approach:
The goal of early ED-based treatment of PCS posterior circulation stroke is to consider if the patient is eligible for reperfusion strategies
Reperfusion considerations – Thrombolytic therapy
Reperfusion considerations – Endovascular therapy
Once patient is diagnosed with posterior circulation stroke, management is similar to all other strokes:
Inform radiology of posterior circulation concern.
NOVEL (Neuro-Ophthalmology Virtual Education Library)
Vestibular Testing In Acute Vestibular Syndrome
Vestibulo-ocular reflex and head impulse testing
Neuro-Vestibular Examination (pages 1-3)
Developed by the ACEP Expert Panel on Posterior Circulation Stroke
Review by the ACEP Clinical Resource Review Committee
Support made possible by Genentech
Edward C. Jauch, MD, MS (Chair)
Opeolu Adeoye, MD, MS, FACEP
Rhonda Cadena, MD, FNCS, FCCM
Christine Holmstedt, DO, FAHA
Arthur Pancioli, MD, FACEP
Riane V. Gay, MPA, CAE
Liz Muth, CAE
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