Turk J Cerebrovasc Dis. Ahead of Print: TJCVD-46338

Posterior Circulation Stroke: Diagnostic and Therapeutic Challenges in the Emergency Department

Ýrem Aydoðdu¹, Engin Ozakin², Atilla Özcan Özdemir³, Özlem aykaç³, Zehra Uysal kocabaþ³, Nurdan Acar², Muhammed Evvah Karakýlýç², Filiz Baloðlu Kaya², Mustafa Emin Canakci², Çaðlar Kuas², Volkan Ercan^2
1Istanbul Haseki Training And Research Hospital,Istanbul,Türkiye
²Eskisehir Osmangazi University, Department of Emergency Medicine, Eskisehir, Türkiye
³Eskisehir Osmangazi University, Department of Neurology, Eskisehir, Türkiye

INTRODUCTION: This study aimed to evaluate the diagnostic and therapeutic challenges of posterior circulation stroke in the emergency department, identify clinical presentation patterns, laboratory findings, and factors associated with clinical outcomes.
METHODS: This single-center, retrospective observational study was conducted in collaboration with the Emergency Department and Department of Neurology at XXX hospital between 2019 and 2023. A total of 606 patients diagnosed with posterior circulation stroke were included. Clinical, laboratory, imaging, treatment data, time-to-hospital arrival, reperfusion therapies, and outcomes were analyzed.
RESULTS: The most common presenting symptoms were vertigo (38.6%), nausea/vomiting (35.5%), speech disturbance (32.2%), and altered mental status (28.9%). Only 13% of the patients received intravenous thrombolysis, and 7.8% underwent endovascular therapy. In the majority of 480 patients (77%) who could not receive treatment, late presentation (>4.5 hours) was detected. Advanced age, elevated glucose, creatinine, and BUN levels, as well as lower hemoglobin values, were found to be more frequent in the poor outcome group.
DISCUSSION AND CONCLUSION: Posterior circulation strokes pose significant challenges in emergency care due to their non-specific symptoms and delayed recognition. Enhancing clinical awareness, improving triage protocols, and refining diagnostic algorithms may facilitate early identification, timely treatment, and better outcomes for this underrecognized stroke subtype.

Keywords: Posterior circulation stroke, emergency department, ischemic stroke, thrombolytic therapy, endovascular treatment, prognosis

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Posterior Dolaþým Ýnmesi: Acil Serviste Taný ve Tedavi Zorluklarý

Ýrem Aydoðdu¹, Engin Ozakin², Atilla Özcan Özdemir³, Özlem aykaç³, Zehra Uysal kocabaþ³, Nurdan Acar², Muhammed Evvah Karakýlýç², Filiz Baloðlu Kaya², Mustafa Emin Canakci², Çaðlar Kuas², Volkan Ercan^2
1T.C Saðlýk Bakanlýðý Ýstanbul Haseki ve Araþtýrma Hastanesi, Acil Servis, Ýstanbul, Türkiye
²Eskisehir Osmangazi Üniversitesi, Acil Týp Anabilim Dalý, Eskisehir, Türkiye
³Eskisehir Osmangazi Üniversitesi, Nöroloji Anabilim Dalý Eskisehir, Türkiye

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, posterior dolaþým inmelerinin acil servis koþullarýnda taný ve tedavisinde karþýlaþýlan zorluklarý deðerlendirmek, klinik sunum özelliklerini, laboratuvar bulgularýný ve sonlanýmlarla iliþkili faktörleri belirlemektir.
YÖNTEM ve GEREÇLER: Hastalarýn baþvuru semptomlarý arasýnda baþ dönmesi (%38,6), bulantý-kusma (%35,5), konuþma bozukluðu (%32,2) ve bilinç deðiþikliði (%28,9) ön planda yer aldý. Olgularýn yalnýzca %13’üne intravenöz tromboliz ve %7,8’ine endovasküler tedavi uygulanabildi. Tedavi alamayan 480 hastanýn (%77) çoðunda geç baþvuru (>4.5 saat) saptandý. Ýleri yaþ, yüksek glukoz, kreatinin ve BUN düzeyleri ile düþük hemoglobin deðerleri kötü sonlaným grubunda daha fazla olduðu görüldü.
BULGULAR: Hastalarýn baþvuru semptomlarý arasýnda baþ dönmesi (%38,6), bulantý-kusma (%35,5), konuþma bozukluðu (%32,2) ve bilinç deðiþikliði (%28,9) ön planda yer aldý. Olgularýn yalnýzca %13’üne intravenöz tromboliz ve %7,8’ine endovasküler tedavi uygulanabildi. Tedavi alamayan hastalarýn çoðunda geç baþvuru (>4.5 saat) saptandý. Kötü klinik sonlanýmla anlamlý iliþkili faktörler arasýnda ileri yaþ, yüksek glukoz, kreatinin ve BUN düzeyleri ile düþük hemoglobin deðerleri yer aldý.
TARTIÞMA ve SONUÇ: Posterior dolaþým inmeleri, özgül olmayan semptomlarla seyretmesi ve taný koymadaki gecikmeler nedeniyle acil servislerde yönetimi güç inme alt grubudur. Bu hasta grubunun erken tanýnmasýný kolaylaþtýracak klinik farkýndalýk, triyaj sistemleri ve tanýsal algoritmalarýn geliþtirilmesi, tedaviye eriþimi ve prognozu iyileþtirebilir.

Anahtar Kelimeler: Posterior dolaþým inmesi, acil servis, iskemik inme, trombolitik tedavi, endovasküler tedavi, prognoz

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