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Unusual Vascular Events In The Territory Of The Posterior Cerebral Artery.

Fisher Cm
Published 1986 · Medicine

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10 cases are presented in which a posterior cerebral artery (PCA) deficit developed suddenly in dramatic fashion with headache visual symptoms sensory and motor deficits and signs of 3rd nerve involvement. There were 9 females and 1 male ranging in age from 18-51 years with 7 cases under age 35. In 9 of the 10 patients headache was prominent at the onset; 6 patients reported being dramatically stricken with a severe sharp localized pain in the forehead or occiput. Visual symptoms were prominent at the onset in 7 patients -- 4 patients experiencing blindness and 3 patients a hemianoptic deficit. Hemisensory symptoms or deficit occurred in 6 instances a hemiparesis in 3 combined weakness and sensory deficit in 1. Evidence of a 3rd nerve palsy was found in 3 cases. A persisting neurologic deficit occurred in 10 cases -- visual field defect 6 cases; hemiplegia 1; slight weakness 1; and a sensory deficit 2. A movement disorder developed on the involved side in 7 cases. Evidence of infarction in 1 or both occipital lobes was obtained in 6 patients. 1 patient did not have impaired visual fields and the other 3 were examined before the days of nuclear medicine and CT scanning. Conventional angiography was performed in 8 patients with the following results: retrothalamic occlusion of 1 PCA (1 patient); distal occlusion of 1 PCA (1 patient); retrothalamic narrowing of 1 PCA (1 patient); irregularity of the wall of the upper basilar artery and both PCAs (1 patient); and in 4 angiography was normal. A digital subtraction angiogram in 1 patient was normal; 1 patient did not have an arteriogram. A history of accompanied migraine was obtained in 3 patients. 1 patient was pregnant; 1 patient was 3 months postpartum. 1 patient was taking oral contraceptives; 1 patient had taken 1 contraceptive pill and 1 patient was receiving injections of estrogen. These cases represent involvement of the territory of the PCA. They share the same features in varied combinations. The onset or evolution is dramatic distinctive or alarming. The cases do not fall easily into any commonly recognized category of cerebrovascular disturbances. The process that most likely applies to this group of cases is migraine. If that is so the term "catastropic migraine" or "cataclysmic migraine" may have some currency. If it is assumed that the process is ischemic and since vascular obstruction was found in 2 cases the possibility of using heparin therapy might be considered. In most of the present cases steroid therapy was used to control brain swelling. If the pathologic process is temporary vasospasm the use of hemodilution or hyperbaric oxygen could be an option.
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Acute confusional states secondary to infarctions in the territory of the posterior cerebral artery in elderly patients
A. Nicolai (2006)
Recovery from occipital stroke: a self-report and an inquiry into visual processes.
B. Kolb (1990)
Cerebrovascular arterial dissection in children and young adults.
G. Silverboard (2000)
Confusional states following posterior cerebral artery infarction.
O. Devinsky (1988)
Motor vehicle accidents: the most common cause of traumatic vertebrobasilar ischemia.
M. Beaudry (2003)
Posterior cerebral artery territory infarcts: clinical features, infarct topography, causes and outcome. Multicenter results and a review of the literature.
T. Brandt (2000)
Tremor in Patients With Migraine
C. Duval (2006)
Migraine‐related stroke: brain infarction in superior cerebellar artery territory demonstrated by nuclear magnetic resonance
F. Titus (1989)
The posterior cerebral artery syndrome.
C. Fisher (1986)
Migraine-related strokes. Clinical profile and prognosis in 20 patients.
J. Broderick (1987)
Vertebrobasilar Ischemia and Hemorrhage: Clinical Findings, Diagnosis and Management of Posterior Circulation Disease
L. Caplan (2015)
Tremor in patients with complicated migraine.
M. Veilleux (1989)
Temporary is not always benign: similarities and differences between transient ischemic attack and angina.
A. Carolei (2013)
Endovascular treatment of vertebral artery dissections and pseudoaneurysms.
V. Halbach (1993)
Etiopathogenesis and prognosis of cerebral ischemia in young adults.
G. Lanzino (1991)
Recurrent primary thunderclap headache and benign CNS angiopathy
S-P Chen (2006)
When the left brain is not right the right brain may be left: report of personal experience of occipital hemianopia
M. Cole (1999)
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