WS is typically due to ischemia from a vertebral artery or posterior inferior cerebellar artery infarction.1 This monograph highlights the neuro-ophthalmic presentations for the WS. Patients with anterior and posterior circulation disease should be treated in the same way 3. In patients with lateral PICA territory cerebellar infarction, the most common symptom at onset is acute unsteadiness, gait ataxia, and unilateral limb ataxia (. Wallenberg syndrome (WS) is a neurological disorder that is due to damage to the lateral portion of the medulla oblongata (i.e., the lateral medullary syndrome). Radiographic featuresĬT, which is the main brain imaging modality in hyperacute stroke, unfortunately, has a known limited sensitivity to assess strokes involving the posterior circulation, especially in the posterior fossa structures 1-3. Other causes are arterial stenosis, in situ thrombosis, and vertebral artery dissection (this one especially in young patients) 1. So, just by chance, we could expect around 1/5th of cardiac origin emboli going to the posterior circulation 3. When comparing the amount of blood carried by each system, ~40% of brain blood flow goes into each ICA (totalising ~80% of brain blood flow provided by the anterior circulation) and only 20% into the vertebrobasilar system. Posterior Inferior Cerebellar Artery (PICA) Infarct Ambra Case Link. PICA infarct can lead to deficits in gait and postural stability, coordination, and Cognition and. The posterior inferior cerebellar artery (PICA) supplies the inferior portion of the cerebellum. Despite the rarity of cerebellar strokes, their impact can cause severe acute neurological morbidity. These two systems share the same vascular coats and are under the same arterial pressures 3. 3.4 of the 600,000 strokes that occur annually in the United States are cerebellar strokes. Pathologyīoth the anterior and posterior circulations have embolism from the heart, aorta, and proximal arteries as the main cause of infarction. It is important to emphasize that the face arm speech test (FAST), a prehospital stroke screening tool, is less sensitive in posterior circulation infarctions and it may be one cause of delay on the diagnosis 1. These are uncommon causes of ischemic infarctions, making up about 0.3-4.4 of stroke cases in series reports. Less than 1% of patients present with one symptom 4. Anterior cerebral artery strokes occur in the territory of the anterior cerebral artery which involves the superior and medial part of the parietal lobe along with the midline of the frontal lobe. Common symptoms and signs include dizziness/vertigo, dysarthria, dysphagia, unilateral limb weakness, ataxia, gaze palsy/diplopia, and/or visual field deficits. 13 Adams 1 was the first who completely described the syndrome associated with AICA occlusion. Symptoms and the clinical syndromes are related to each common site of arterial blood flow occlusion. In infarction involving the distribution of the anterior inferior cerebellar artery (AICA), vertigo is usually associated with other neurological symptoms or signs such as hearing loss, facial weakness, facial sensory loss, crossed sensory loss, Horner syndrome, gait ataxia, and limb ataxia. Posterior circulation infarctions correspond to around 20% of all ischemic strokes 1,2.
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