Endovascular thrombectomy for posterior cerebral artery strokes in the national inpatient sample (EaT PeCANpIeS) study.

BACKGROUND: Posterior cerebral arteries with acute ischemic strokes (PCA-AISs) comprise around 2% of all acute ischemic strokes and may result in significant long-term deficits. Current guidance regarding endovascular thrombectomy (EVT) for PCA-AIS is insufficient as no published randomized trials exist. METHODS: An analysis of the National Inpatient Sample database compared medical management versus EVT for PCA-AIS. Propensity score matching was applied to adjust for nonrandomization. RESULTS: The study included 19,655 patients. Before matching, the EVT cohort had significantly higher National Institutes of Health Stroke Scale (NIHSS) (10.21 vs. 4.67, p < 0.001), had lower rates of favorable functional outcomes, functional independence, and higher rates of intracranial hemorrhage (ICH) and inpatient mortality. After matching, no differences in functional outcomes were identified, but revealed a higher proportion of ICH in the EVT group (17.45% vs. 8.98%, p < 0.001). However, NIHSS subgroup analysis identified improved functional outcomes associated with the EVT group who presented with an NIHSS between 10 and 19 both in terms of rates of favorable functional outcomes (35.56% vs. 12.09%, p < 0.001) and rates of functional independence (26.67% vs. 9.34%, p < 0.01). On further investigation, the clinical benefit, in the NIHSS 10-19 subgroup, was driven by patients receiving EVT in combination with intravenous thrombolysis (IVT). CONCLUSIONS: This analysis shows that current national practices utilize EVT for more severe PCA strokes. Clinical benefit was only detected in patients with moderate stroke severity (NIHSS 10-19) who were treated with combined EVT and IVT. Further work is needed to investigate the features of PCA-AIS that might benefit from EVT the most.

A Rare Case of Prosopagnosia Related to Intracranial Hemorrhage.

Prosopagnosia describes the inability to recognize others by their faces, which may be hereditary or acquired. Acquired cases result from intracranial lesions such as intracranial hemorrhage or ischemia. This case demonstrates acquired prosopagnosia secondary to an intracranial hemorrhage and thus exemplifies the importance of early symptom recognition for appropriate diagnosis and management. A 58-year-old female presented to the emergency department with a chief complaint of the worst headache of her life along with nausea and vomiting. She also reported that she was unable to recognize her children in photos and although she knew her husband was with her, she did not recognize his face. Physical examination revealed no focal motor deficits. Computed tomography angiography of the brain revealed intracerebral hemorrhage of the right occipital lobe. Acquired prosopagnosia can be the only presenting symptom of intracranial pathology. It is most commonly caused by intracranial hemorrhage, as shown in this case report. This demonstrates a unique symptom of posterior circulation strokes that are commonly misdiagnosed in the emergency department.

Massive Left Ventricular Thrombus Causing Bilateral Posterior Cerebral Artery Stroke: A Case Report and Review of Literature.

Left ventricular thrombus (LVT) is a major complication of acute myocardial infarction (MI). Here, we describe the case of a 36-year-old female with a history of acute anterior MI six years prior to hospitalization, who presented with bilateral vision loss due to a bilateral embolic posterior cerebral artery (PCA) stroke in the setting of a 5.7 x 1.7 cm LVT. She underwent bilateral PCA thrombectomy, which led to improvement of her symptoms. Her LVT was managed non-surgically with apixaban and clopidogrel. Her case highlights the need for more medical education about LVT, as quick initiation of anticoagulation is essential in improving outcomes. We review the existing literature to explain the pathogenesis, diagnosis, and treatment of LVT.

A Rare Presentation of Posterior Cerebral Artery Stroke With Monocular Hemianopia After Diesel Exposure.

Acute ischemic stroke of the posterior cerebral artery (PCA) presents with variable symptoms that may initially make it challenging to diagnose. Common etiologies of PCA stroke include large and small artery disease, atherosclerosis, and cardioembolism. We present a 69-year-old male, initially diagnosed with sinusitis at an urgent care facility, who presented with worsening headache and peripheral vision loss following exposure to diesel vapor and exhaust. Physical examination revealed a right monocular temporal hemianopia and subsequent imaging showed infarction of the left occipital lobe. Due to the length of time between the onset of the infarct and medical treatment, angiography and physical intervention were not indicated and management was done medically. This case presents a unique exposure prior to the development of a PCA stroke, as well as an atypical visual defect and suggests that physicians should consider neuroimaging in patients with nonspecific neurological findings such as new-onset headache and vision changes.

The influence of the non-Newtonian properties of blood on blood-hammer through the posterior cerebral artery.

This work investigates a two dimensional numerical analysis of blood hammer through the posterior cerebral artery. The non-Newtonian and usual Newtonian blood models are compared in the case of blood hammer through the posterior cerebral artery to quantify the differences between the models. In this way, a validated CFD simulation is used to study non-Newtonian shear-thinning effects of blood. The governing equations for the modeling of two-dimensional transient flow are solved using a combination of characteristics and central finite difference methods, respectively for the hyperbolic and parabolic parts. Herein, the non-Newtonian viscosity characteristic of blood is incorporated by using the Carreau model. To convert the nonlinear terms available in the characteristics equation into the linear ones, the Newton-Kantorovich method is implemented. The verification and validation of the numerical results are carried out in detail. Hemodynamic characteristics of blood hammer through the posterior cerebral artery are derived with both the Newtonian and non-Newtonian models, and the results are meticulously compared and discussed. The results show that when blood hammer occurs, the non-Newtonian properties greatly influence the velocity and shear stress profiles. At the early stages of blood hammer, there is a 64% difference between magnitudes of wall shear stress in these two models, and the magnitude of the wall shear stress for the shear-thinning blood flow is lower than the Newtonian one.