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Research paper
Posterior versus anterior circulation strokes: comparison of clinical, radiological and outcome characteristics
  1. Gian Marco De Marchis1,
  2. Adrian Kohler1,
  3. Nora Renz1,
  4. Marcel Arnold1,
  5. Marie-Luise Mono1,
  6. Simon Jung1,
  7. Urs Fischer1,
  8. Alexander I Karameshev1,
  9. Caspar Brekenfeld2,
  10. Jan Gralla2,
  11. Gerhard Schroth2,
  12. Heinrich P Mattle1,
  13. Krassen Nedeltchev1
  1. 1Department of Neurology, University of Bern, Switzerland
  2. 2Department of Neuroradiology, University of Bern, Switzerland
  1. Correspondence to Dr G M De Marchis, Department of Neurology, University of Bern, Inselspital, Freiburgstrasse 10, CH-3010 Bern, Switzerland; gianmarcodemarchis{at}


Background and purpose Physicians treating patients with posterior circulation strokes (PCS) tended to debate more on whether or not to introduce anticoagulation rather than performing investigations to identify stroke aetiology, as in patients with anterior circulation strokes (ACS). Recent findings suggest that stroke aetiologies of PCS and ACS are more alike than dissimilar, suggesting that PCS deserve the same investigations as ACS. The characteristics and current diagnostic evaluation between patients with PCS and ACS were compared.

Methods 312 consecutive patients with first ever ACS and 93 patients with first ever PCS were prospectively analysed.

Results Patients with ACS and PCS did not differ in terms of demographic characteristics, prevalence of vascular risk factors, diagnostic evaluation or stroke aetiology. The median National Institutes of Health Stroke Scale score was 8 in ACS and 4 in PCS (p=0.004). Brain imaging revealed more often pathological findings in ACS than PCS. The proportion of non-thrombolysed patients with a favourable clinical outcome (modified Rankin score 0–2) was similar in ACS and PCS (67.0% vs 78.4%; p=0.08). In non-thrombolysed patients, stroke severity was an independent predictor of clinical outcome both in ACS (OR 1.60, 95% CI 1.2 to 2.1; p<0.0001) and in PCS (OR 1.22, 95% CI 1.03 to 1.44; p=0.02) while age predicted poor outcome only in ACS (OR 1.11, 95% CI 1.01 to 1.22; p=0.007). In thrombolysed patients, stroke severity was the only outcome predictor in ACS (OR 1.14, 95% CI 1.04 to 1.25; p=0.004) while we identified no statistically relevant predictor of PCS outcome.

Conclusions In PCS and ACS, baseline variables, aetiology and outcome are more alike than different.

  • Clinical neurology

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  • Funding The scientific fund of the Inselspital Bern, Switzerland, funded the research discussed in the study.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ethics committee of the Canton of Bern, Switzerland.

  • Provenance and peer review Not commissioned; externally peer reviewed.