A clinical study of incidence, risk factor profile, and prognosis in cases of posterior circulation stroke

Background: The etiology of posterior circulation ischemia has been thought to be primarily due to local arterial atherosclerosis (large artery disease) and penetrating artery disease (lacunes). However, there is increasing evidence that cardiogenic embolization is more common than previously suspected and is responsible for 20-50% of posterior circulation strokes. Aim and objective: To study the clinical manifestations, risk factor profile, and prognosis in this sample of patients. Materials and methods: 54 cases of posterior circulation strokes, admitted to the Department of Medicine, Rajah Muthiah Medical College, and Hospital, Chidambaram, during the period from September 2016 to October 2017, who fulfilled the inclusion criteria, were taken up for the study. Results: Out of 54 patients, 48.1% had hypertension, 37.0% had diabetes, 37.0% had tobacco abuse, 37.0% had alcohol abuse, 40.7% had dyslipidemia, 7.4% had TIA/Stroke, 11.1% had RHD, 27.8% had IHD and 7.4% had MVP as predisposing factors. Majority of the patients had hypertension as a risk factor followed by dyslipidemia. Many patients had multiple predisposing factors. 46.3% had their consciousness impaired, 59.3% had speech disturbances, 13.0% had cranial nerve involvement, 55.6% had motor disturbances, 13.0% had sensory disturbances, 48.1% had cerebellar signs, 37.0% had nystagmus and 44.4% had fundal changes. Majority of the patients had speech disturbances on clinical examination. Conclusion: Majority of the patients had Hypertension (48.1%) as a risk factor followed by Dyslipidemia (40.7%). Many patients had multiple predisposing factors. There is an increased association between coronary artery disease and posterior circulation strokes in our study (27.8%). Infratentorial lesions (50%) were more common than supratentorial lesions (38.9%) and both combined (11.1%). The mortality associated with posterior circulation strokes in our study is 16.7%. Majority of the patients had no disability (22.2%) or slight disability (18.5%).