Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Acad Emerg Med. 2019 Nov;26(11):1273-1284. doi: 10.1111/acem.13830. Epub 2019 Aug 11.
Posterior circulation strokes represent 20% of all acute ischemic strokes. Posterior circulation stroke patients are misdiagnosed twice as often compared to those with anterior events. Misdiagnosed patients likely have worse outcomes than correctly diagnosed patients because they are at risk for complications of the initial stroke as well as recurrent events due to lack of secondary stroke prevention and failure to treat the underlying vascular pathology. Understanding important anatomic variants, the clinical presentations, relevant physical examination findings, and the limitations of acute brain imaging may help reduce misdiagnosis. We present a symptom-based review of posterior circulation ischemia focusing on the subtler presentations with a brief discussion of basilar stroke, both of which can be missed by the emergency physician. Strategies to avoid misdiagnosis include establishing an abrupt onset of symptoms, awareness of the nonspecific presentations, consideration of basilar stroke in altered patients and using a modern approach to diagnosis of the acutely dizzy patient.
后循环卒中占所有急性缺血性卒中的 20%。与前循环事件患者相比，后循环卒中患者的误诊率高出两倍。误诊患者的预后可能比正确诊断的患者更差，因为他们不仅有初始卒中的并发症风险，而且由于缺乏二级卒中预防和未能治疗潜在的血管病变，还存在复发性事件的风险。了解重要的解剖变异、临床表现、相关体格检查结果以及急性脑成像的局限性，可能有助于减少误诊。我们基于症状对后循环缺血进行了综述，重点介绍了较细微的表现，并简要讨论了基底动脉卒中，这两者都可能被急诊医生漏诊。避免误诊的策略包括确定症状的突然发作、认识到非特异性表现、在意识改变的患者中考虑基底动脉卒中，并采用现代方法诊断急性眩晕患者。
