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Posterior circulation cerebrovascular syndromes: diagnosis and management
  1. Ursula G Schulz1,
  2. Urs Fischer2
  1. 1Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, Oxford, UK
  2. 2Department of Neurology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
  1. Correspondence to Dr Ursula Schulz, Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK; ursula.schulz{at}


One in five strokes affects the posterior circulation. Diagnosing posterior circulation stroke can be challenging, as the vascular anatomy can be variable, and because presenting symptoms are often non-specific and fluctuating. Nevertheless, making the correct diagnosis is important, as these strokes have a high chance of recurrence, can be life threatening, and can lead to equally life-threatening complications. Investigation and management largely follow those for stroke in general, although some specific differences exist. These include the preferred use of MRI for diagnosing posterior fossa lesions, the management of basilar artery thrombosis, which may have a longer time window for recanalisation therapy, and the use of endovascular therapies for secondary prevention, which, so far, have not shown any benefit in the treatment of vertebral or basilar artery stenosis. In this review, we summarise the anatomy, aetiology and presentation of posterior circulation stroke, and discuss current approaches to management.


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  • Contributors US reviewed the literature and drafted the manuscript. UGF reviewed and commented on the manuscript and co-wrote the sections on diagnosis and management of basilar artery occlusion.

  • Funding US is part funded by the NIHR Biomedical Research Centre.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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