![]() ![]() NIHSS gives us a brief evaluation of acuity, determination of appropriate treatment, and can predict patient outcomes. The National Institutes of Health Stroke Scale (NIHSS) is a systematic assessment tool that provides a quantitative measure of stroke-related neurologic deficits. Patient history may include unilateral weakness, sensory deficits, language dysfunction, dizziness, nausea, vomiting, cognitive, and behavioral disturbances.Ī physical exam is performed as soon as a physician sees the patient. Patients may report visual problems such as grayness, spots, voids, and difficulties focusing. Many times, they are also unaware of their visual problems. Mild symptoms in the setting of a PCA stroke may delay a patient from getting medical treatment. Patients with a PCA stroke may present with only a headache and mild visual changes such as vision loss, diplopia, inability to see half of the view, or difficulty reading perceiving colors, or recognizing familiar faces. Patients may present in a comatose state via ambulance or may walk to an emergency department without assistance. Modifiable risk factors include hypertension, diabetes mellitus, hyperlipidemia, smoking, heart disease (atrial fibrillation, endocarditis) oral contraceptives, substance abuse (cocaine), poor diet, obesity, immobility, and sleep apnea. The segments can be further categorized into deep and superficial segments or proximal and distal, respectively. PCA is divided into four segments, P1 to P4. The PCAs then give off branches to the midbrain, subthalamic nucleus, basal nucleus, thalamus, temporal, occipital, and occipitoparietal cortices (See Figure). PCAs can originate from BA 70 percent of the time, 20 percent of the time from PCOMs, and 10 percent of the time from a mix of the two. The BA typically divides into PCAs near the pituitary stalk at the pontomesencephalic junction. The VAs arise from the subclavian arteries and fuse into the BA within the cranium. Posterior circulation is supplied by the vertebral arteries (VA), posterior inferior cerebellar arteries (PICA), basilar artery (BA), anterior inferior cerebellar arteries (AICA), pontine branches of the basilar artery, superior cerebellar arteries (SCA), PCA, and PCOM. ![]() When there is an occlusion in the cerebral vasculature, the circle of Willis, as well as collateral circulations, provide blood to the occluded areas. Both circulations are connected by the posterior communicating arteries (PCOM), which make up the circle of Willis. Anterior and posterior circulations provide the primary blood circulation of the brain. A solid understanding of the pathophysiology of a posterior cerebral artery (PCA) stroke as well as the syndrome relating to it, requires adequate knowledge of the structures and vascular anatomy of the brain.
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