Study on clinical patterns and risk factors in posterior circulation stroke

AIM : 1. To study the risk factors and clinical profile of patients admitted to Medical wards and intensive medical care unit of Tirunelveli Medical College Hospital with posterior circulation stroke. 2. To study the distribution of infarcts in different territories within the posterior circulation. 3. To compare the results with NEMC –Posterior circulation stroke registry and other available similar studies. MATERIALS AND METHODS : This was a cross sectional observation study conducted in all patients admitted to the General Medicine wards and Intensive Medical care unit with clinical features suggestive of posterior circulation stroke. All patients with evidence of posterior circulation stroke in clinical features and/or imaging were taken up for the study based on strict inclusion and exclusion criteria. Patients’ details regarding various risk factors and clinical features were recorded on a well thought out and carefully prepared proforma. The data was analysed and the results were compared with other available similar studies. RESULTS : The average age of patients in this study was 60.2 years. Of the 50 patients studied, 74 % were males and 26 % were females. Most of the patients were above 50 years of age. Hypertension was found to be the most important risk factor (64 %) followed by smoking, hyperlipidemia and diabetes. Smoking was found to be more important than hypertension among males (75 %). The most common clinical symptoms were nausea and vomiting (54%), giddiness (50%), motor weakness (44%), visual field defects (36%) and ataxia (42%). Cranial nerve involvement was noticed in 28 % of patients. The territory of infarct commonly involved was the distal territory (48%), which includes midbrain, thalamus, occipital and temporal lobes and SCA supplied cerebellum. These results were compared with NEMC – PCSR and various other studies. The results were comparable between these studies. CONCLUSIONS : All patients with brain ischemia deserve full evaluation of their brain for vascular lesions. Evaluation of risk factors and cardiac investigations are just as important as brain imaging, because a sizeable number of posterior circulation infarcts are cardio embolic, furthermore, brainstem infarcts, especially medullary infarcts can cause cardiac abnormalities. By controlling these risk factors, we can reduce the incidence of posterior circulation stroke to a certain extent