Posterior circulation stroke refers to the vascular occlusion or bleeding, arising from the vertebrobasilar vasculature of the brain. Determine when to triage posterior circulation stroke patients to ICU, neuro-stepdown or floor. Identify patients with posterior circulation stroke. PCIS is a clinical syndrome associated with ischemia-related changes in the territory of the posterior circulation arteries. Conclusions Taken together, these data suggest that headache is common at the onset of or shortly following ischemic stroke and may contribute to poststroke morbidity. To determine which study characteristics likely contribute to the heterogeneity, we examined the relationship between the individual moderator variables and the prevalence. Yet the therapeutic needs of this patient subpopulation remain largely unknown. It is unknown if and to what extent traction and mechanical forces, electrical events like spreading depolarization, platelet-derived factors, serotonergic mechanisms, or peptide-containing nociceptors contribute to HAIS. Better understanding of headache associated with ischemic stroke is needed to establish treatment guidelines and inform patient management. To our knowledge, this is the first meta-analysis of HAIS prevalence and risk factors. Enter and update disclosures at http://submit.neurology.org. Copyright © 2019 The Author(s). Stroke affecting the posterior circulation continues to pose particular challenges for clinicians. Clinical studies show that individuals who experience posterior circulation stroke will develop significant brain injury, neurologic dysfunction, or death. Migraine was not systematically assessed in many of the studies included in these meta-analyses. Exception: replies can include all original authors of the article. However, there are few trials evaluating the benefit of clot retrieval in posterior circulation strokes. Exception: replies to comments concerning an article you originally authored do not require updated disclosures. You have a loss of coordinated arm or leg movements. Future research should therefore be directed towards clinical trials of the efficacy of established headache preventive medications for the treatment of HAIS and secondary prevention approaches. To determine the effect of stroke location (posterior vs anterior circulation) and sex on ischemic stroke headache, data from studies that reported headache prevalence in these subgroups were used to calculate a crude odds ratio (OR) using 2 × 2 tables for each study and combined using a fixed effects heterogeneity model to generate a pooled estimate. While an overlap with migraine pathogenesis (i.e., activation of trigeminovascular afferents or meningeal inflammation) has been postulated, that HAIS is qualitatively different from migraine suggests otherwise. Recognize the limitations associated with clinical scale assessments that determine eligibility for acute reperfusion treatment. 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Calculated crude odds ratios (ORs) showed that posterior circulation stroke (pooled OR 1.92, 95% CI 1.4–2.64; n = 7 studies) and female sex (pooled OR 1.25, 95% CI 1.07–1.46; n = 11 studies) had greater odds of headache associated with ischemic stroke. More guidelines and information on Disputes & Debates, Neurology | Print ISSN:0028-3878 Online ISSN:1526-632X, The most widely read and highly cited peer-reviewed neurology journal. In particular, we recommend that future cohort studies (1) report clear inclusion and exclusion criteria; (2) use ICHD criteria to define HAIS; (3) use ICHD criteria to define a preexisting history of migraine or other primary headache disorder; (4) report descriptive characteristics of HAIS, including demographic information and headache quality, severity, timing, and accompanying symptoms; and (5) report HAIS rates by ischemic stroke etiology and location. Medline and PubMed electronic databases were queried using the search terms “headache after stroke” or “poststroke headache” or “onset headache and stroke” and “headache and stroke.” Abstracts of observational and clinical studies written in English and containing the search terms in the title or abstract body were reviewed. 'Royal Free Hospital'. Isolated homonymous hemianopia Please note that both TACS and PACS involve the anterior and middle cerebral arteries (ACA and MCA), whilst the PoCS involves the posterior circulation. Some defined it as a presenting symptom during an ischemic stroke, onset simultaneous with or in close temporal relationship to stroke onset. Posterior circulation strokes often strike fear in the hearts of neurologists. Embolism is the most common stroke mechanism in posterior circulation. Similarly, in a different cohort, 80% of patients had bilateral and pressure-like headache, whereas only 16% had throbbing and 10% had stabbing pain.37 In this study, 30% had photophobia, 24% phonophobia, and 28% nausea or vomiting. The data presented in this study add to the previously published systematic reviews by integrating prior studies and using statistical methods to provide a more precise estimate of headache prevalence in the stroke population. Headache associated with ischemic stroke (HAIS) was variably defined among the studies. Consistent with the findings of the meta-analysis, other studies also reported an association between posterior circulation stroke and HAIS. C. Ayata: support is provided by the Foundation Leducq, Heitman Foundation, and the Ellison Foundation Awards. Prevalence of headache after ischemic stroke (IS) and characteristics of studies included in the meta-analysis. For example, most studies did not state whether ICHD criteria were used, potentially leading to differences in when and how HAIS was defined. Publication bias was graphically represented with funnel and doi plots.13. Acute ischemic stroke (AIS) is characterized by the sudden loss of blood circulation to an area of the brain, typically in a vascular territory, resulting in a corresponding loss of neurologic function. This includes your brain stem, cerebellum (the area responsible for balance and coordination) and occiptal lobes (the area responsible for vision). This International journal, Journal of Clinical Neuroscience publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The topographic distribution of the posterior-circulation ischaemic stroke in patients who underwent MRI brain (n = 20). When North America was used as the referent level, there was no significant difference in prevalence between European and North American studies (table 2). CI = confidence interval. Patients with posterior circulation stroke (PCS) were underrepresented in randomized trials on mechanical thrombectomy (MT). Patients who present with symptoms of a lacunar stroke, but who have not yet had diagnostic imaging performed, may be described as suffering from lacunar stroke syndrome (LACS). Perspective of the acute phase. [The clinical characteristics of patients with posterior circulation ischemic stroke]. The reproducible association between headache and ischemic stroke, and the close temporal relationship between the headache and stroke symptom onset, strongly argue against the headache being a random occurrence. Early diagnosis of basilar artery occlusion using magnetic resonance imaging. •Recognize features of posterior circulation stroke involving: •Posterior cerebral artery (occipital lobe, thalamus, medial temporal lobe) •Brainstem (midbrain, pons, medulla) •Cerebellum •Recognize four common lacunar stroke syndromes •Pure motor stroke •Pure sensory stroke •Sensorimotor stroke •Ataxic hemiparesis Meta-analysis using an inverse-variance heterogeneity model revealed a pooled prevalence of 0.14 (95% confidence interval [CI] 0.07–0.23) with heterogeneity among studies. 22,28,36,43,e59,e62 In a small cohort study of 57 posterior circulation strokes, a large majority (79%) had accompanying headache. 11 21 ACUTE ASSESSMENT SCALES INTRACEREBRAL HEMORRHAGE SCALE (ICH SCORE) • Uses a 5-item scale • Predictor of 30 day mortality • Developed to standardize clinical grading to … Publication bias may have influenced the pooled prevalence estimate given the wide distribution of studies on the funnel plot and the asymmetric doi plot (figure 3). Read any comments already posted on the article prior to submission. 'Orthopedic Surgeon'. Objective Headache associated with ischemic stroke is poorly understood. Results Headache occurred in 6%–44% of the ischemic stroke population. Metaregression revealed a significant association between prevalence and study location, the source population's national human development index (HDI), and study quality. However, because of study limitations and methodologic heterogeneity between studies, the results presented herein underscore the need for future prospective studies to better estimate the true HAIS incidence and prevalence. The aim of this study was to determine the frequency, clinical and radiological features, and efficacy of clinical evaluation and perfusion-weighted imaging (PWI) for the prediction of final stroke in patients with DWI/MRI-negative posterior circulation stroke (PCS) presenting acute dizziness/vertigo. Finally, no clinical trials on poststroke headache treatments were found in this review of the literature. Stay timely. The midbrain, pons, and medulla oblongata are components of the brainstem which control basic body functions such as consciousness, breathing, proprioception, … Cerebellar or brainstem syndromes 2.
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