Beyond textbook neuroanatomy: The syndrome of malignant PCA infarction.
Given its limited vascular territory, occlusion of the posterior cerebral artery (PCA) usually does not result in malignant infarction. Challenging this concept, we present 3 cases of unilateral PCA infarction with secondary malignant progression, resulting from extension into what would classically be considered the posterior middle cerebral artery (MCA) territory. Interestingly, these were true PCA infarctions, not "MCA plus" strokes, since the underlying occlusive lesion was in the PCA. We hypothesize that congenital and/or acquired variability in the distribution and extent of territory supplied by the PCA may underlie this rare clinical entity. Patients with a PCA infarction should thus be followed closely and offered early surgical decompression in the event of malignant progression.
a Department of Neurosurgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA.
Steven L
SL
Gogela
a Department of Neurosurgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA.
Yair M
YM
Gozal
a Department of Neurosurgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA.
Ralph
R
Rahme
a Department of Neurosurgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA.|b Cerebrovascular Center at University of Cincinnati Neuroscience Institute , Cincinnati , OH , USA.|c Mayfield Clinic , Cincinnati , OH , USA.
Mario
M
Zuccarello
a Department of Neurosurgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA.|b Cerebrovascular Center at University of Cincinnati Neuroscience Institute , Cincinnati , OH , USA.|c Mayfield Clinic , Cincinnati , OH , USA.
Andrew J
AJ
Ringer
D002548:Cerebral Revascularization / Q000379:methods; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020762:Infarction, Posterior Cerebral Artery / Q000473:pathology* / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009445:Neuroanatomy; D019635:Neurosurgical Procedures / Q000379:methods; D010291:Paresis / Q000209:etiology; D020769:Posterior Cerebral Artery / Q000473:pathology* / Q000601:surgery*; D012151:Resuscitation; D020521:Stroke / Q000209:etiology / Q000473:pathology / Q000601:surgery; D013577:Syndrome; D016896:Treatment Outcome
decompressive craniectomy; hemicraniectomy; malignant infarction; middle cerebral artery; posterior cerebral artery