Posterior circulation cerebrovascular syndromes – Diagnosis and Management

One in five strokes affect the posterior circulation. Diagnosing posterior circulation stroke can be challenging, as the vascular anatomy can be variable, and because presenting symptoms are often non-specific and fluctuating. Nevertheless, making the correct diagnosis is important, as these strokes have a high chance of recurrence, can be life threatening, and can lead to equally life-threatening complications. Investigation and management largely follow those for stroke in general, although some specific differences exist. These include the preferred use of MRI for diagnosing posterior fossa lesions, the management of basilar artery thrombosis, which may have a longer time window for recanalization therapy, and the use of endovascular therapies for secondary prevention, which so far has not shown any benefit in the treatment of vertebral or basilar artery stenosis. In this review, we summarize the anatomy, aetiology and presentation of posterior circulation stroke, and discuss current approaches to management