Etiopathogenesis and predictors of in-hospital morbidity and mortality in posterior circulation strokes--a 2 year registry with concordant comparison with anterior circulation strokes.

ABSTRACT

AIMS: To determine etiopathogenetic factors, predictors of in-hospital morbidity and mortality, and discharge status in a serially recruited cohort of PCS patients at a tertiary care hospital. Comparison of data between ACS and PCS groups was also done. METHODS: Seventy six cases of PCS and 108 cases of ACS were serially recruited, within 48 hrs of stroke onset, over a 2 year period. Vascular territory determination, stroke subtype and classification, risk factor profile and outcome measures were determined. RESULTS: 77.6% of PCS strokes were ischemic in origin. A cardioembolic source was seen in 12/29 (42%) PCS cases. Intraarterial cause was seen in 5/29 (17.2%) PCS cases. 22.3% of PCS and 24% of ACS patients developed dysphagia. Pneumonia developed in 70% and 65% of dysphagic patients in PCS and ACS groups respectively. Mortality in PCS group was 14/76 (18%) and in ACS group 17/108 (15.7%). The principal contributory factors to mortality in PCS were low Glasgow coma score at presentation, development of respiratory morbidity, and vascular lesions in 'middle plus distal' territory. At discharge, 62% PCS patients were in group 2-3 of modified Rankin scale and 64% of ACS patients were in group 3-4. CONCLUSIONS: A cardiac source of distal territory infarct was significantly commoner in PCS as compared to ACS. Incidence of post-stroke complications, viz. dysphagia, pneumonia, deep venous thrombosis, bed-sores and urinary infection, was comparable in the two groups. Dysphagia, seen in 22% PCS and 24% of ACS, was the principal causation of pneumonia. Mortality and disability status at discharge were comparable in the 2 groups.