This study analyzed the topography of acute ischemic stroke in the posterior cerebral artery (PCA) territory. We studied 84 patients with unilateral ischemic PCA stroke. Patients were classified according to lesion levels as cortico-subcortical (superficial), combined (cortical and mesodiencephalic) or isolated thalamic. To receive a lesion map, data from acute MR and CT imaging were normalized and labelled automatically by mapping to stereotaxic anatomical atlases. Cortical lesions accounted for 41.7%, combined for 36.9%, and isolated thalamic lesions for 21.4%. The maximum overlay of ischemia and, thus, highest occurrence of PCA ischemic stroke was found in the ventral and medial occipito-temporal cortex and adjacent white matter association tracts. Dorsal and peripheral segments of the occipito-temporo-parietal region were only rarely lesioned. This configuration was similar in both hemispheres. Consistent with this lesion pattern, visual field defects (VFD) were the most frequent signs, followed by sensorimotor signs, dizziness and sopor, cognitive and oculomotor deficits, and ataxia. The three vascular subgroups differed not only by their anatomical lesion profile and lesion load, but also by their clinical manifestation; although patients with combined and thalamic lesions were sigificantly younger, they were more disabled than participants with cortical lesions. VFD were only found in cortical and combined, and oculomotor deficits only in mesodiencephalic lesions. White matter lesions were common in the cortico-subcortical and the combined group. Basal occipito-temporal and calcarine regions, and neighbouring white matter tracts have the highest risk of ischemia in acute PCA stroke.

本研究分析了大脑后动脉 (PCA) 区域急性缺血性卒中的地形。我们研究了 84 名单侧缺血性 PCA 卒中患者。患者根据病变水平分为皮质-皮质下（浅表）、联合（皮质和中二脑）或孤立的丘脑。为了接收病灶图，来自急性 MR 和 CT 成像的数据通过映射到立体定位解剖图谱被自动归一化和标记。皮质病变占41.7%，合并占36.9%，孤立性丘脑病变占21.4%。在腹侧和内侧枕颞皮层和相邻的白质关联束中发现了最大的缺血重叠，因此，PCA 缺血性中风的发生率最高。枕-颞-顶区的背侧和外周部分很少受到损伤。这种配置在两个半球中是相似的。与这种病变模式一致，视野缺损 (VFD) 是最常见的体征，其次是感觉运动体征、头晕和嗜睡、认知和眼球运动障碍以及共济失调。三个血管亚组的不同不仅在于它们的解剖病变轮廓和病变负荷，还在于它们的临床表现。虽然合并丘脑病变的患者明显更年轻，但与皮质病变的参与者相比，他们的残疾程度更高。VFD 仅见于皮质和联合，而动眼神经缺陷仅见于中脑损伤。白质病变在皮质-皮质下和联合组中很常见。基底枕颞区和距状区以及邻近的白质束在急性 PCA 中风中具有最高的缺血风险。