Management of Posterior Cerebral Artery Infarcts

Acute Management

The American Heart Association recommends performing rapid neurological assessment to identify stroke symptoms and determine eligibility for reperfusion therapies 1
Neuroimaging (CT/CTA or MRI/MRA) should be obtained to confirm PCA territory infarction and rule out hemorrhage, as recommended by the Journal of Neurointerventional Surgery 2
Assessment for early signs of cerebral edema is crucial, as posterior circulation strokes can develop significant swelling, according to Stroke 3
Intravenous thrombolysis is recommended if within 4.5 hours of symptom onset, as per the American Heart Association guidelines 1
Mechanical thrombectomy is a reasonable option for PCA large vessel occlusion, with a Class IIa, Level of Evidence B-NR recommendation from the American Heart Association 2

Monitoring for signs of increased intracranial pressure is essential, as edema typically peaks 3-4 days after stroke, according to the American Heart Association 1 and Stroke 3
Standard edema prevention measures should be implemented, including elevating the head of bed 20-30° to assist venous drainage, as recommended by the American Heart Association 1
Osmotic therapy with mannitol may be considered for patients with significant edema, as per the American Heart Association guidelines 1

Referral to a Speech-Language Pathologist (SLP) for comprehensive assessment of communication deficits is recommended, according to the International Journal of Stroke 4
Early intensive language and communication therapy should be implemented according to patient needs, goals, and impairment severity, with an Evidence Level B recommendation from the International Journal of Stroke 4
Antiplatelet therapy, such as aspirin (75-325 mg daily), is recommended for patients with vertebral atherosclerosis, with a Level of Evidence B recommendation from Stroke 5

An individualized patient-centered approach with an interdisciplinary team is recommended, as per the International Journal of Stroke 4