Posterior circulation stroke causes a wide range of non-specific presenting symptoms
More than a third of posterior circulation strokes are initially misdiagnosed
Explore the possibility of posterior circulation stroke in patients with new vertigo or disequilibrium, and those with new headache or changed migraine
A negative HINTS examination in a patient with isolated vertigo can help rule out posterior circulation ischaemia
A 63 year old man with a history of migraine with visual aura, hypertension, and anxiety presented to the local emergency department with a five day history of headache (see “A patient’s perspective”). This headache started similarly to previous migrainous episodes, but became more severe than usual and was accompanied by intermittent double vision and disturbed balance, speech, and swallowing. The patient was treated in the emergency department with intravenous fluids and analgesia and discharged with a diagnosis of migraine. The following day, his symptoms worsened; clinical examination revealed vertical diplopia, gaze-evoked jerk nystagmus, right sided past-pointing, and an ataxic gait. Computed tomography (CT) of the head and CT angiography demonstrated an acute right superior cerebellar artery territory infarct and thrombus in the V3 and V4 (distal) segments of the right vertebral artery; subsequent brain magnetic resonance imaging (MRI) revealed other posterior circulation infarcts (fig 1).
Magnetic resonance imaging (MRI) of brain of the patient described in the case history. Axial T2 sequences (A, B) and axial diffusion weighted sequences (C, D) show acute infarcts (arrows) in the right occipital lobe (A, C) and right cerebellum (B, D). Contrast enhanced magnetic resonance angiography (E) shows an abrupt occlusion of the right vertebral artery (thick arrow). The left vertebral artery (thin arrow) continues via a tortuous route, before terminating in the posterior inferior cerebellar artery (interrupted arrow). The basilar artery (arrowhead) receives no flow from either vertebral artery, and …

中文翻译：

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后循环缺血性中风

后循环中风引起广泛的非特异性表现症状
最初误诊了三分之一以上的后循环中风
探索患有新眩晕或不平衡以及新头痛或偏头痛
的患者后循环中风的可能性对孤立性眩晕患者进行检查有助于排除后循环缺血
一名63岁的男子，有偏头痛史，伴有视觉先兆，高血压和焦虑症，现向当地急诊科就诊，头痛病史为5天（请参阅“患者的观点”）。头痛的发作类似于以前的偏头痛发作，但变得比平时更严重，并伴有间歇性双眼视力和平衡，言语和吞咽障碍。该患者在急诊科接受了静脉输液和止痛治疗，出院后诊断为偏头痛。第二天，他的症状恶化了。临床检查显示垂直复视，凝视诱发的混动性眼球震颤，右侧指向前方和共济失调的步态。头部计算机断层扫描（CT）和CT血管造影显示，在右椎动脉的V3和V4（远端）节段中出现了急性右小脑上动脉区梗塞和血栓。随后的脑磁共振成像（MRI）显示了其他后循环梗塞（图1）。
病史中描述了患者大脑的磁共振成像（MRI）。轴向T2序列（A，B）和轴向扩散加权序列（C，D）在右枕叶（A，C）和右小脑（B，D）中显示急性梗塞（箭头）。对比增强磁共振血管造影（E）显示右椎动脉突然闭塞（粗箭头）。左椎动脉（细箭头）沿曲折路线继续延伸，然后终止于小脑后下动脉（箭头间断）。基底动脉（箭头）没有从任何一个椎动脉流出，并且…