Intended for healthcare professionals


Posterior circulation stroke: still a Cinderella disease

BMJ 2013; 346 doi: (Published 14 June 2013) Cite this as: BMJ 2013;346:f3552
  1. Hedley C A Emsley, consultant neurologist
  1. 1Department of Neurology, Royal Preston Hospital, Preston PR2 9HT, UK
  1. hedley.emsley{at}

Improved clinical recognition, specific diagnostic imaging, and studies of treatment are urgently needed to optimise care

Although enormous strides have been made recently in hyperacute stroke care in the United Kingdom, one stroke presentation continues to pose particular challenges. Clinicians who treat patients with a transient ischaemic attack (TIA) or ischaemic stroke that affects the posterior circulation face difficulties in making the diagnosis, accessing imaging, and treating the condition effectively. Healthcare professionals in emergency settings urgently need to acquaint themselves with the signs of the acute neurological deficits associated with posterior circulation stroke.

Posterior circulation stroke accounts for about a fifth of the estimated 150 000 strokes that occur in the UK each year.1 Simple screening methods have been devised to identify patients with an acute stroke or TIA and ensure early intervention. The “face arm speech test” (FAST) score in particular has been developed to assess whether a patient is likely to have had an acute stroke and may be a candidate for intravenous thrombolysis. This score was primarily evaluated in a cohort of unselected patients with acute stroke, most of whom had anterior circulation (carotid territory) stroke.

Clinical features of stroke affecting the posterior circulation (usually in the territory of the vertebrobasilar system) differ substantially from those of anterior circulation stroke. Common posterior circulation symptoms include visual disturbance, vertigo, and ataxia (box). The …

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