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Posterior Versus Anterior Circulation Infarction How Different Are the Neurological Deficits?
Distinguishing between symptoms of posterior circulation infarction (PCI) and anterior circulation infarction (ACI) can be challenging. This study evaluated the frequency of symptoms/signs in the 2 vascular territories to determine the diagnostic value of particular symptoms/signs for PCI. Neurologi...
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| Published in: | Stroke (1970) 2012-08, Vol.43 (8), p.2060-2065 |
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| Main Authors: | , , , , , , , , , , |
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| container_end_page | 2065 |
| container_issue | 8 |
| container_start_page | 2060 |
| container_title | Stroke (1970) |
| container_volume | 43 |
| creator | TAO, Wen-Dan MING LIU BO WU FISHER, Marc WANG, De-Ren JIE LI FURIE, Karen L HAO, Zi-Long SEN LIN ZHANG, Cai-Fei ZENG, Quan-Tao |
| description | Distinguishing between symptoms of posterior circulation infarction (PCI) and anterior circulation infarction (ACI) can be challenging. This study evaluated the frequency of symptoms/signs in the 2 vascular territories to determine the diagnostic value of particular symptoms/signs for PCI.
Neurological deficits were reviewed and compared from 1174 consecutive patients with a diagnosis of PCI or ACI confirmed by magnetic resonance imaging in the Chengdu Stroke Registry. The diagnostic value of specific symptoms/signs for PCI was determined by measuring their sensitivity, specificity, positive predictive value (PPV), and the OR.
Homolateral hemiplegia (PCI, 53.6% versus ACI, 74.9%; P |
| doi_str_mv | 10.1161/STROKEAHA.112.652420 |
| format | article |
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Neurological deficits were reviewed and compared from 1174 consecutive patients with a diagnosis of PCI or ACI confirmed by magnetic resonance imaging in the Chengdu Stroke Registry. The diagnostic value of specific symptoms/signs for PCI was determined by measuring their sensitivity, specificity, positive predictive value (PPV), and the OR.
Homolateral hemiplegia (PCI, 53.6% versus ACI, 74.9%; P<0.001), central facial/lingual palsy (PCI, 40.7% versus ACI, 62.2%; P<0.001), and hemisensory deficits (PCI, 36.4% versus ACI, 34.2%; P=0.479) were the 3 most common symptoms/signs in PCI and ACI. The signs with the highest predictive values favoring a diagnosis of PCI were Horner's syndrome (4.0% versus 0%; P<0.001; PPV=100.0%; OR=4.00), crossed sensory deficits (3.0% versus 0%; P<0.001; PPV=100.0%; OR=3.98), quadrantanopia (1.3% versus 0%; P<0.001; PPV=100.0%; OR=3.93), oculomotor nerve palsy (4.0% versus 0%; P<0.001; PPV=100.0%; OR=4.00), and crossed motor deficits (4.0% versus 0.1%; P<0.001; PPV=92.3%; OR=36.04); however, all had a very low sensitivity, ranging from 1.3% to 4.0%.
This study indicates that the symptoms/signs considered typical of PCI occur far less often than was expected. Inaccurate localization would occur commonly if clinicians relied on the clinical neurological deficits alone to differentiate PCI from ACI. Neuroimaging is vital to ensure accurate localization of cerebral infarction.]]></description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.112.652420</identifier><identifier>PMID: 22678088</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Cerebral Infarction - complications ; Cerebral Infarction - pathology ; Female ; Glasgow Coma Scale ; Hemianopsia - etiology ; Hemiplegia - etiology ; Horner Syndrome - etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; Nervous System Diseases - etiology ; Nervous System Diseases - pathology ; Neurology ; Neuropharmacology ; Neurotransmitters. Neurotransmission. Receptors ; Ophthalmoplegia - etiology ; Paralysis - etiology ; Pharmacology. Drug treatments ; Predictive Value of Tests ; Registries ; Risk Factors ; Sensation Disorders - etiology ; Serotoninergic system ; Stroke - etiology ; Stroke - pathology ; Vascular diseases and vascular malformations of the nervous system ; Young Adult</subject><ispartof>Stroke (1970), 2012-08, Vol.43 (8), p.2060-2065</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c286t-fda8c49f8fc3a404b456b9e868d92313aec9d8e91363d60075f4f78a68864a083</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26185105$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22678088$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>TAO, Wen-Dan</creatorcontrib><creatorcontrib>MING LIU</creatorcontrib><creatorcontrib>BO WU</creatorcontrib><creatorcontrib>FISHER, Marc</creatorcontrib><creatorcontrib>WANG, De-Ren</creatorcontrib><creatorcontrib>JIE LI</creatorcontrib><creatorcontrib>FURIE, Karen L</creatorcontrib><creatorcontrib>HAO, Zi-Long</creatorcontrib><creatorcontrib>SEN LIN</creatorcontrib><creatorcontrib>ZHANG, Cai-Fei</creatorcontrib><creatorcontrib>ZENG, Quan-Tao</creatorcontrib><title>Posterior Versus Anterior Circulation Infarction How Different Are the Neurological Deficits?</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description><![CDATA[Distinguishing between symptoms of posterior circulation infarction (PCI) and anterior circulation infarction (ACI) can be challenging. This study evaluated the frequency of symptoms/signs in the 2 vascular territories to determine the diagnostic value of particular symptoms/signs for PCI.
Neurological deficits were reviewed and compared from 1174 consecutive patients with a diagnosis of PCI or ACI confirmed by magnetic resonance imaging in the Chengdu Stroke Registry. The diagnostic value of specific symptoms/signs for PCI was determined by measuring their sensitivity, specificity, positive predictive value (PPV), and the OR.
Homolateral hemiplegia (PCI, 53.6% versus ACI, 74.9%; P<0.001), central facial/lingual palsy (PCI, 40.7% versus ACI, 62.2%; P<0.001), and hemisensory deficits (PCI, 36.4% versus ACI, 34.2%; P=0.479) were the 3 most common symptoms/signs in PCI and ACI. The signs with the highest predictive values favoring a diagnosis of PCI were Horner's syndrome (4.0% versus 0%; P<0.001; PPV=100.0%; OR=4.00), crossed sensory deficits (3.0% versus 0%; P<0.001; PPV=100.0%; OR=3.98), quadrantanopia (1.3% versus 0%; P<0.001; PPV=100.0%; OR=3.93), oculomotor nerve palsy (4.0% versus 0%; P<0.001; PPV=100.0%; OR=4.00), and crossed motor deficits (4.0% versus 0.1%; P<0.001; PPV=92.3%; OR=36.04); however, all had a very low sensitivity, ranging from 1.3% to 4.0%.
This study indicates that the symptoms/signs considered typical of PCI occur far less often than was expected. Inaccurate localization would occur commonly if clinicians relied on the clinical neurological deficits alone to differentiate PCI from ACI. Neuroimaging is vital to ensure accurate localization of cerebral infarction.]]></description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cerebral Infarction - complications</subject><subject>Cerebral Infarction - pathology</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Hemianopsia - etiology</subject><subject>Hemiplegia - etiology</subject><subject>Horner Syndrome - etiology</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous System Diseases - etiology</subject><subject>Nervous System Diseases - pathology</subject><subject>Neurology</subject><subject>Neuropharmacology</subject><subject>Neurotransmitters. Neurotransmission. Receptors</subject><subject>Ophthalmoplegia - etiology</subject><subject>Paralysis - etiology</subject><subject>Pharmacology. Drug treatments</subject><subject>Predictive Value of Tests</subject><subject>Registries</subject><subject>Risk Factors</subject><subject>Sensation Disorders - etiology</subject><subject>Serotoninergic system</subject><subject>Stroke - etiology</subject><subject>Stroke - pathology</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><subject>Young Adult</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNpFkNtKxDAQhoMouh7eQKQ3gjfVnJpOr6SshxVFxdOdlGw60Ui3WZMW8e2t7qpXMz98_wx8hOwyesiYYkf3D3c3l6flpBwiP1QZl5yukBEbllQqDqtkRKkoUi6LYoNsxvhGKeUCsnWywbnKgQKMyPOtjx0G50PyhCH2MSnbZR67YPpGd863yUVrdTA_68R_JCfOWgzYdkkZMOleMbnGPvjGvzijm-QErTOui8fbZM3qJuLOcm6Rx7PTh_Ekvbo5vxiXV6nhoLrU1hqMLCxYI7SkciozNS0QFNQFF0xoNEUNWDChRK0ozTMrbQ5aASipKYgtcrC4Ow_-vcfYVTMXDTaNbtH3sWKU5yAyxvMBlQvUBB9jQFvNg5vp8DlA1bfY6k_sEHm1EDvU9pYf-ukM67_Sr8kB2F8COg4ObNCtcfGfUwwyRjPxBaEwgcg</recordid><startdate>20120801</startdate><enddate>20120801</enddate><creator>TAO, Wen-Dan</creator><creator>MING LIU</creator><creator>BO WU</creator><creator>FISHER, Marc</creator><creator>WANG, De-Ren</creator><creator>JIE LI</creator><creator>FURIE, Karen L</creator><creator>HAO, Zi-Long</creator><creator>SEN LIN</creator><creator>ZHANG, Cai-Fei</creator><creator>ZENG, Quan-Tao</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120801</creationdate><title>Posterior Versus Anterior Circulation Infarction How Different Are the Neurological Deficits?</title><author>TAO, Wen-Dan ; MING LIU ; BO WU ; FISHER, Marc ; WANG, De-Ren ; JIE LI ; FURIE, Karen L ; HAO, Zi-Long ; SEN LIN ; ZHANG, Cai-Fei ; ZENG, Quan-Tao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c286t-fda8c49f8fc3a404b456b9e868d92313aec9d8e91363d60075f4f78a68864a083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cerebral Infarction - complications</topic><topic>Cerebral Infarction - pathology</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Hemianopsia - etiology</topic><topic>Hemiplegia - etiology</topic><topic>Horner Syndrome - etiology</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nervous System Diseases - etiology</topic><topic>Nervous System Diseases - pathology</topic><topic>Neurology</topic><topic>Neuropharmacology</topic><topic>Neurotransmitters. Neurotransmission. Receptors</topic><topic>Ophthalmoplegia - etiology</topic><topic>Paralysis - etiology</topic><topic>Pharmacology. Drug treatments</topic><topic>Predictive Value of Tests</topic><topic>Registries</topic><topic>Risk Factors</topic><topic>Sensation Disorders - etiology</topic><topic>Serotoninergic system</topic><topic>Stroke - etiology</topic><topic>Stroke - pathology</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>TAO, Wen-Dan</creatorcontrib><creatorcontrib>MING LIU</creatorcontrib><creatorcontrib>BO WU</creatorcontrib><creatorcontrib>FISHER, Marc</creatorcontrib><creatorcontrib>WANG, De-Ren</creatorcontrib><creatorcontrib>JIE LI</creatorcontrib><creatorcontrib>FURIE, Karen L</creatorcontrib><creatorcontrib>HAO, Zi-Long</creatorcontrib><creatorcontrib>SEN LIN</creatorcontrib><creatorcontrib>ZHANG, Cai-Fei</creatorcontrib><creatorcontrib>ZENG, Quan-Tao</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>TAO, Wen-Dan</au><au>MING LIU</au><au>BO WU</au><au>FISHER, Marc</au><au>WANG, De-Ren</au><au>JIE LI</au><au>FURIE, Karen L</au><au>HAO, Zi-Long</au><au>SEN LIN</au><au>ZHANG, Cai-Fei</au><au>ZENG, Quan-Tao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Posterior Versus Anterior Circulation Infarction How Different Are the Neurological Deficits?</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2012-08-01</date><risdate>2012</risdate><volume>43</volume><issue>8</issue><spage>2060</spage><epage>2065</epage><pages>2060-2065</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract><![CDATA[Distinguishing between symptoms of posterior circulation infarction (PCI) and anterior circulation infarction (ACI) can be challenging. This study evaluated the frequency of symptoms/signs in the 2 vascular territories to determine the diagnostic value of particular symptoms/signs for PCI.
Neurological deficits were reviewed and compared from 1174 consecutive patients with a diagnosis of PCI or ACI confirmed by magnetic resonance imaging in the Chengdu Stroke Registry. The diagnostic value of specific symptoms/signs for PCI was determined by measuring their sensitivity, specificity, positive predictive value (PPV), and the OR.
Homolateral hemiplegia (PCI, 53.6% versus ACI, 74.9%; P<0.001), central facial/lingual palsy (PCI, 40.7% versus ACI, 62.2%; P<0.001), and hemisensory deficits (PCI, 36.4% versus ACI, 34.2%; P=0.479) were the 3 most common symptoms/signs in PCI and ACI. The signs with the highest predictive values favoring a diagnosis of PCI were Horner's syndrome (4.0% versus 0%; P<0.001; PPV=100.0%; OR=4.00), crossed sensory deficits (3.0% versus 0%; P<0.001; PPV=100.0%; OR=3.98), quadrantanopia (1.3% versus 0%; P<0.001; PPV=100.0%; OR=3.93), oculomotor nerve palsy (4.0% versus 0%; P<0.001; PPV=100.0%; OR=4.00), and crossed motor deficits (4.0% versus 0.1%; P<0.001; PPV=92.3%; OR=36.04); however, all had a very low sensitivity, ranging from 1.3% to 4.0%.
This study indicates that the symptoms/signs considered typical of PCI occur far less often than was expected. Inaccurate localization would occur commonly if clinicians relied on the clinical neurological deficits alone to differentiate PCI from ACI. Neuroimaging is vital to ensure accurate localization of cerebral infarction.]]></abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>22678088</pmid><doi>10.1161/STROKEAHA.112.652420</doi><tpages>6</tpages></addata></record> |
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| ispartof | Stroke (1970), 2012-08, Vol.43 (8), p.2060-2065 |
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| source | Alma/SFX Local Collection |
| subjects | Adult Aged Biological and medical sciences Cerebral Infarction - complications Cerebral Infarction - pathology Female Glasgow Coma Scale Hemianopsia - etiology Hemiplegia - etiology Horner Syndrome - etiology Humans Magnetic Resonance Imaging Male Medical sciences Middle Aged Nervous System Diseases - etiology Nervous System Diseases - pathology Neurology Neuropharmacology Neurotransmitters. Neurotransmission. Receptors Ophthalmoplegia - etiology Paralysis - etiology Pharmacology. Drug treatments Predictive Value of Tests Registries Risk Factors Sensation Disorders - etiology Serotoninergic system Stroke - etiology Stroke - pathology Vascular diseases and vascular malformations of the nervous system Young Adult |
| title | Posterior Versus Anterior Circulation Infarction How Different Are the Neurological Deficits? |
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