Posterior circulation infarcts simulating anterior circulation stroke: Perspective of the acute phase

Corrado Argentino, Manuela De Michele, Marco Fiorelli, Danilo Toni, Maria Luisa Sacchetti, Cristina Cavalletti, Giuliano Sette, Anne Falcou, Stefano Bastianello, Luigi Bozzao

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background and Purpose: Ischemic stroke patients whose initial clinical presentation suggests an involvement of the anterior circulation (AC) are sometimes found to have a posterior circulation (PC) infarct, a fact that may generate erroneous decisions in clinical management. We investigated the prevalence of this misdiagnosis in the first few hours after stroke onset. Methods: We performed a cohort study of 158 patients hospitalized within 5 hours of onset of a presumed AC ischemic stroke, as diagnosed on clinical grounds. Results: Final CT or pathology diagnosis was AC infarct in 128 patients (81%), a repeatedly negative CT in 14 (9%), PC infarct (5 pons, 1 midbrain and cerebellum, 6 supratentorial territory of the posterior cerebral artery) in 12 (8%), and other or undiagnosed lesions in 4 (3%). AC and PC stroke patients did not differ in terms of age, vascular risk factors, and initial severity, but the latter were more frequently men (83% versus 53%; P .04), were hospitalized later (mean±SD, 168±86 versus 109±55 minutes; P=.001), and presented a pure motor hemiparesis or a sensorimotor stroke (50% versus 33%) more often than their counterparts. At baseline CT, PC stroke patients never exhibited an early parenchymal hypodensity in the carotid territory or a hyperdense middle cerebral artery, which were instead found in 59% (P=.0003) and 31% (P=.02) of AC stroke patients, respectively. Early neurological deterioration, 1 month casefatality rate, and disablement in survivors were comparable in the two groups. Conclusions: Shortly after onset the clinical discrimination between AC and nontypical PC infarcts is not reliable, which explains the frequent occurrence of this misdiagnosis. Emergency CT scan helps in the differential diagnosis only when it demonstrates an early focal hypodensity within the carotid territory.

Original languageEnglish
Pages (from-to)1306-1309
Number of pages4
JournalStroke
Volume27
Issue number8
Publication statusPublished - Aug 1996

Fingerprint

Stroke
Diagnostic Errors
Posterior Cerebral Artery
Pons
Middle Cerebral Artery
Paresis
Mesencephalon
Cerebellum
Survivors
Emergencies
Differential Diagnosis
Cohort Studies
Pathology

Keywords

  • cerebral ischemia
  • diagnosis
  • stroke assessment
  • vertebrobasilar circulation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Argentino, C., De Michele, M., Fiorelli, M., Toni, D., Sacchetti, M. L., Cavalletti, C., ... Bozzao, L. (1996). Posterior circulation infarcts simulating anterior circulation stroke: Perspective of the acute phase. Stroke, 27(8), 1306-1309.

Posterior circulation infarcts simulating anterior circulation stroke : Perspective of the acute phase. / Argentino, Corrado; De Michele, Manuela; Fiorelli, Marco; Toni, Danilo; Sacchetti, Maria Luisa; Cavalletti, Cristina; Sette, Giuliano; Falcou, Anne; Bastianello, Stefano; Bozzao, Luigi.

In: Stroke, Vol. 27, No. 8, 08.1996, p. 1306-1309.

Research output: Contribution to journalArticle

Argentino, C, De Michele, M, Fiorelli, M, Toni, D, Sacchetti, ML, Cavalletti, C, Sette, G, Falcou, A, Bastianello, S & Bozzao, L 1996, 'Posterior circulation infarcts simulating anterior circulation stroke: Perspective of the acute phase', Stroke, vol. 27, no. 8, pp. 1306-1309.
Argentino C, De Michele M, Fiorelli M, Toni D, Sacchetti ML, Cavalletti C et al. Posterior circulation infarcts simulating anterior circulation stroke: Perspective of the acute phase. Stroke. 1996 Aug;27(8):1306-1309.
Argentino, Corrado ; De Michele, Manuela ; Fiorelli, Marco ; Toni, Danilo ; Sacchetti, Maria Luisa ; Cavalletti, Cristina ; Sette, Giuliano ; Falcou, Anne ; Bastianello, Stefano ; Bozzao, Luigi. / Posterior circulation infarcts simulating anterior circulation stroke : Perspective of the acute phase. In: Stroke. 1996 ; Vol. 27, No. 8. pp. 1306-1309.
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abstract = "Background and Purpose: Ischemic stroke patients whose initial clinical presentation suggests an involvement of the anterior circulation (AC) are sometimes found to have a posterior circulation (PC) infarct, a fact that may generate erroneous decisions in clinical management. We investigated the prevalence of this misdiagnosis in the first few hours after stroke onset. Methods: We performed a cohort study of 158 patients hospitalized within 5 hours of onset of a presumed AC ischemic stroke, as diagnosed on clinical grounds. Results: Final CT or pathology diagnosis was AC infarct in 128 patients (81{\%}), a repeatedly negative CT in 14 (9{\%}), PC infarct (5 pons, 1 midbrain and cerebellum, 6 supratentorial territory of the posterior cerebral artery) in 12 (8{\%}), and other or undiagnosed lesions in 4 (3{\%}). AC and PC stroke patients did not differ in terms of age, vascular risk factors, and initial severity, but the latter were more frequently men (83{\%} versus 53{\%}; P .04), were hospitalized later (mean±SD, 168±86 versus 109±55 minutes; P=.001), and presented a pure motor hemiparesis or a sensorimotor stroke (50{\%} versus 33{\%}) more often than their counterparts. At baseline CT, PC stroke patients never exhibited an early parenchymal hypodensity in the carotid territory or a hyperdense middle cerebral artery, which were instead found in 59{\%} (P=.0003) and 31{\%} (P=.02) of AC stroke patients, respectively. Early neurological deterioration, 1 month casefatality rate, and disablement in survivors were comparable in the two groups. Conclusions: Shortly after onset the clinical discrimination between AC and nontypical PC infarcts is not reliable, which explains the frequent occurrence of this misdiagnosis. Emergency CT scan helps in the differential diagnosis only when it demonstrates an early focal hypodensity within the carotid territory.",
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T2 - Perspective of the acute phase

AU - Argentino, Corrado

AU - De Michele, Manuela

AU - Fiorelli, Marco

AU - Toni, Danilo

AU - Sacchetti, Maria Luisa

AU - Cavalletti, Cristina

AU - Sette, Giuliano

AU - Falcou, Anne

AU - Bastianello, Stefano

AU - Bozzao, Luigi

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N2 - Background and Purpose: Ischemic stroke patients whose initial clinical presentation suggests an involvement of the anterior circulation (AC) are sometimes found to have a posterior circulation (PC) infarct, a fact that may generate erroneous decisions in clinical management. We investigated the prevalence of this misdiagnosis in the first few hours after stroke onset. Methods: We performed a cohort study of 158 patients hospitalized within 5 hours of onset of a presumed AC ischemic stroke, as diagnosed on clinical grounds. Results: Final CT or pathology diagnosis was AC infarct in 128 patients (81%), a repeatedly negative CT in 14 (9%), PC infarct (5 pons, 1 midbrain and cerebellum, 6 supratentorial territory of the posterior cerebral artery) in 12 (8%), and other or undiagnosed lesions in 4 (3%). AC and PC stroke patients did not differ in terms of age, vascular risk factors, and initial severity, but the latter were more frequently men (83% versus 53%; P .04), were hospitalized later (mean±SD, 168±86 versus 109±55 minutes; P=.001), and presented a pure motor hemiparesis or a sensorimotor stroke (50% versus 33%) more often than their counterparts. At baseline CT, PC stroke patients never exhibited an early parenchymal hypodensity in the carotid territory or a hyperdense middle cerebral artery, which were instead found in 59% (P=.0003) and 31% (P=.02) of AC stroke patients, respectively. Early neurological deterioration, 1 month casefatality rate, and disablement in survivors were comparable in the two groups. Conclusions: Shortly after onset the clinical discrimination between AC and nontypical PC infarcts is not reliable, which explains the frequent occurrence of this misdiagnosis. Emergency CT scan helps in the differential diagnosis only when it demonstrates an early focal hypodensity within the carotid territory.

AB - Background and Purpose: Ischemic stroke patients whose initial clinical presentation suggests an involvement of the anterior circulation (AC) are sometimes found to have a posterior circulation (PC) infarct, a fact that may generate erroneous decisions in clinical management. We investigated the prevalence of this misdiagnosis in the first few hours after stroke onset. Methods: We performed a cohort study of 158 patients hospitalized within 5 hours of onset of a presumed AC ischemic stroke, as diagnosed on clinical grounds. Results: Final CT or pathology diagnosis was AC infarct in 128 patients (81%), a repeatedly negative CT in 14 (9%), PC infarct (5 pons, 1 midbrain and cerebellum, 6 supratentorial territory of the posterior cerebral artery) in 12 (8%), and other or undiagnosed lesions in 4 (3%). AC and PC stroke patients did not differ in terms of age, vascular risk factors, and initial severity, but the latter were more frequently men (83% versus 53%; P .04), were hospitalized later (mean±SD, 168±86 versus 109±55 minutes; P=.001), and presented a pure motor hemiparesis or a sensorimotor stroke (50% versus 33%) more often than their counterparts. At baseline CT, PC stroke patients never exhibited an early parenchymal hypodensity in the carotid territory or a hyperdense middle cerebral artery, which were instead found in 59% (P=.0003) and 31% (P=.02) of AC stroke patients, respectively. Early neurological deterioration, 1 month casefatality rate, and disablement in survivors were comparable in the two groups. Conclusions: Shortly after onset the clinical discrimination between AC and nontypical PC infarcts is not reliable, which explains the frequent occurrence of this misdiagnosis. Emergency CT scan helps in the differential diagnosis only when it demonstrates an early focal hypodensity within the carotid territory.

KW - cerebral ischemia

KW - diagnosis

KW - stroke assessment

KW - vertebrobasilar circulation

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