Save ("V") Case #2. Sex: Female. Age: 70 years Gender: Male From the case: PCA territory infarct. Background: Ischemic stroke caused by infarction in the territory of the posterior cerebral artery (PCA) has not been studied as extensively as infarctions in other vascular territories. Patients with infarction in the territory of the left PCA may have preserved macular vision but severe restriction of peripheral vision, as well as an inability to read in any visual field. ... PCA infarct. Patient Data. Diagnosis almost certain Diagnosis almost certain . territory were compared by 3 independent and blinded readers to the CCTs of 86 age-matched patients without PCA infarction. The major PCA segments are the Pre-communicating / Peduncular / P1 segment, Ambient / P2 segment and the Quadrigeminal / P3 segment. Unenhanced head computed tomography (CT) scan demonstrating a subacute L posterior cerebral artery (PCA) infarct. Case contributed by Dr Ian Bickle Diagnosis almost certain Diagnosis almost certain . PCA territory infarct. Presentation. J Neurol . [PubMed] 16. occipital infarct (Figure 1) in the PCA territory and a right frontal infarct. Case Presentation Both patients are 82-year-old right-handed women, both had a large ischemic stroke involving the anterior and posterior circulation territories of one hemisphere, and both were found to have an FPCA. The visual defect often presents as a limitation of vision to one side, and patients usually recognize that they must focus extra attention on the hemianopic field. This article provides an overview of PCA stroke and focuses exclusively on stroke of arterial origin involving the PCA territory (see the images below). Atypical presentations of acute cerebrovascular syndromes. Patient Data. Case contributed by Dr Ian Bickle Diagnosis certain Diagnosis certain . Expand Collapse. Eight hour duration of left sided visual symptoms and dizziness. The P1 segment extends from the PCA origin to the posterior communicating artery, contributing to the circle of Willis. J Clin Neurosci. PCA infarct - Remember that the thalamus is supplied by the PCA Case #3. 18.1 Acute infarct. The middle cerebral artery territory is the most commonly affected territory in a cerebral infarction, due to the size of the territory and the direct flow from the internal carotid artery into the middle cerebral artery, providing the easiest path for thromboembolism. Age: 87. The vascular territory of the PCA is depicted in blue. Indication: Altered mental status. PCA territory Right PCA Left PCA . This is the classically appearances of a posterior cerebral artery territory infarction. Case contributed by Dr David Cuete. Numerous reports have described a variety of clinical syndromes resulting from posterior cerebral artery (PCA) infarction, whereas only a few pathoanatomical and retrospective clinical studies have investigated the underlying mechanisms. Presentation. We assess the clinical features, frequency, and involved PCA territories of the infarction mimicry between these 2 arteries. Moyamoya disease was diagnosed at the same age on the basis of cerebral angiographic findings. Cardioembolism is the main cause of brain infarction in the territory of the ACA. PCA territory infarct. This 79-year-old woman presented 1.5 hours prior to the initial imaging evaluation with clinical signs of ischemia in the left MCA territory. We now review the clinica l features of PCA termors infarcts, in particular findings additional to the visual field deficits, the related infarct territories, and long-term Acute PCA territory infarct Right occipital lobe and thalamic involvement. Edlow JA, Selim MH. METHOD: We reviewed consecutive patients with acute PCA territory infarction who underwent diffusion-weighted MRI (DWI) and magnetic resonance angiography (MRA) within 7 days after onset. Using follow-up imaging, the correlation of the hyperdense PCA (HPCA) with infarct size, thalamic infarction, and bleeding were investigated. Absent flow in right PCA (P2) (Black arrow) in TOF MRA MIP images. 4 article feature images from this case . Patient Data. No infarction in the PCA territory is evident on either side. [Medline] . Computed tomography (CT) … VA atherosclerosis is the most common cause with 18 patients including extracranial and intracranial, followed by 4 patients in the BA. 35-year-old man who initially presented with right hemiparesis and speech disturbance at 3 years of age. Although cytotoxic edema is seen within 15 minutes of ischemia, vasogenic edema occurs later, with 90% of infarcts demonstrating vasogenic edema by 24 hours. The unenhanced CT (not shown) was grossly unremarkable. Infarctions in the territory of the posterior cerebral artery (PCA) occur in about 5-10% of all ischemic strokes. PCA territory infarction may profoundly disrupt memory function 167,222,223 through damage to the hippocampus, the parahippocampus, or the efferents and afferents of these structures. Lancet Neurol. Age: 65 years old Gender: Male From the case: PCA territory infarct. Between 1979 and 1990, we studied retrospectively 76 patients suffering from an occipitotemporal infar … Diffusion-weighted images showing acute lacunar infarct (arrow) in posterior limb of right internal capsule Less common etiologies, representing less than 5 % of acute stroke, include vasculopathies, immune-related ­diseases, hypercoagulable states, arterial dissection, global hypoperfusion, venous infarction, and mitochondrial disorders. Age: 53 Gender: Male From the case: PCA infarct. (See Anatomy, Pathophysiology, Etiology, Treatment, and Medication.) The occipital lobe, medial temporal lobe, and thalamus are all within the posterior cerebral artery (PCA) territory. Note sparring of occipital lobe as well as medial temporal lobe - that belong to Posterior Cerebral Artery PCA territory. Patients with infarction in the territory of the right PCA may have significant visual hemineglect. Right posteromedial temporal lobe infarct. The most frequent finding in patients with a PCA territory infarct is contralateral hemianopia. Spoken language disorders are rarely mentioned in superficial infarction of the posterior cerebral (PCA) territory. Case Discussion. RESULTS: A total of 205 patients (male 56%, mean age 65.4 +/- 12.4 years) were recruited. Methods We studied all patients with a first, isolated infarction restricted to the PCA who were admitted to our stroke center between January 1, 1983, and December 31, 2003. Kobayashi S, Maki T, Kunimoto M. Clinical symptoms of bilateral anterior cerebral artery territory infarction. Acute left subdural hematoma with evidence of severely raised intracranial pressure and acute left PCA territory infarct. A study of 79 patients with infarcts in one or more cortical territories of the PCA shows 25 (32%) patients with proximal arterial disease. White arrow pointing to left PCA P2 segment. Download figure; Open in new tab; Download powerpoint; fig 4. Visual symptoms. Two clinical types have been reported: transcortical sensory and amnesic aphasia. Fig. Also note medial parts of the frontal lobe that belong to Anterior Cerebral Artery ACA. Left PCA infarction on CT This is a thrombus in the left PCA Medial temporal lobe infarct Medial occipital lobe infarct . Lateral posterior choroid arteries (LPCAs) originate from the distal PCA trunk in the proximity of the origin of thalamogeniculate arteries or the cortical branches.1 Infarction of LPCAs, therefore, often accompany lesions of other PCA cortical branches or perforating branches.2 3 Their clinical features have often been masked by the associated and combined cortical and subcortical lesions. 1.55 Hyperacute distal MCA territory infarct, evaluation by CT. Occlusion of paramedian perforating arteries arising from P1 causes rostral midbrain infarction with or without thalamic lesion. Fig. Infarction occurred in the right MCA and PCA territories in Patient 1 and in the left ACA, MCA, and PCA territories in Patient 2. Low Fluid Volume/ Low Blood Pressure. between ACA, MCA, and PCA territories; histologically, these can be wedges of cortical and subcortical infarction or cortical laminar necrosis ; Deep (internal) border zones infarct: between ACA, MCA, and PCA territories and perforating medullary, lenticulostriate, recurrent artery of Heubner and anterior choroidal arteries; Causes. Great case for the signs of raised ICP and the complication of PCA infarct, where the PCA is compressed by uncal herniation across the tent. Posterior thalamoperforating arteries branch off the P1 segment to supply blood to the midbrain and thalamus. [PubMed] 15. Several clinical features are more frequent in stroke patients with ACA infarction than in patients with ischaemic stroke due to infarction in the MCA and PCA territories. 2011 Feb;18(2):218-22. View Media Gallery. The infarct mechanisms in three different types of superficial PCA territory stroke were quite similar, but cardioembolism was found more frequent in those with cortical PCA territory infarction. The PCA can be divided into 'deep' (P1 and P2 segments) and 'superficial' (P3 and P4) segments. 1997 Sep. 244(9):571-8. Infarct sizes were judged on a 3-point scale, with large infarcts comprising more than two thirds of the PCA territory and medium infarcts comprising up to two thirds, but more than one third of the PCA territory and small infarcts comprising less than one third of the PCA territory. Middle aged patient with an acute visual disturbance - right homonymous hemianopia. Although, the cause of stroke could not reliably dictate the infarct topography and clinical features. Findings. Cerebral angiography revealed a subtotal occlusion of the right ICA, with minimal antegrade blood flow and patent cervical and intra-cranial ICA on later films (Figure 2). Presentation. Case #1. Studies are lacking that show small artery disease as a cause of PCA infarcts. 2011 Jun;10(6):550-60. Steinke W, Mangold J, Schwartz A, Hennerici M. Mechanisms of infarction in the superficial posterior cerebral artery territory.