Khorasan posterior circulation stroke registry: a hospital-based study

ABSTRACT

Clinical information about stroke in the vertebrobasilar territory has lagged behind that for anterior circulation syndrome. This is the first report from posterior circulation syndrome registry in Iran. Consecutive patients with brain infarction in vertebrobasilar territory admitted to Ghaem hospital, Mashhad were enrolled in a prospective study during 2006-2007. Diagnosis of ischemic stroke in the posterior circulation was made by a stroke neurologist based on the clinical manifestations and neuroimaging. Vertebrobasilar territory infarcts were classified into five groups according to the location involved brainstem, thalamus, cerebellum, posterior cerebral artery, and mixed categories. All of the stroke patients underwent a standard battery of diagnostic investigations and the etiology of ischemic stroke was determined by the Practical Iranian Criteria classification. The 72-hour stroke course determined as regressive, stable, and deteriorative. Total of 302 patients [147 females, 155 males] with mean age 62.5 years [ +/- 17.2] were investigated. Posterior cerebral artery, thalamus, brain stem, cerebellum, and mixed categories consisted 31.3%, 4.3%, 32.8%, 17.9%, and 13.9% of the stroke topographies respectively. Atherosclerosis consisted 50.6% of etiologies in our patients followed by uncertain [25.5%], cardioembolism [12.5%], both atherosclerosis and cardioembolism [6.3%], and miscellaneous causes [4.6%]. Rheumatic mitral stenosis was the cause in 34.2% of our patients with cardiac emboly. The distribution of stroke etiologies based on its localization was not significantly different [df = 16, and P = 0.421]. Stable status was the most common early stroke course [57.7%] followed by deteriorative [22.1%], and regressive [20.2%]. A significant association between stroke localization in the vertebrobasilar territory and its course was not found [df = 8, and P = 0.901]. Atherosclerosis is the most common cause of posterior circulation syndrome in Iranian patients. The cause of stroke in the posterior circulation could not reliably be derived from infarct topography