Prehospital pathways of occipital stroke patients with mainly visual symptoms

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Excerpt

Posterior cerebral artery strokes constitute approximately 5% to 10% of all strokes.1 Their most common manifestations are visual field abnormalities (54%‐93%),1 which often significantly affect daily functions, such as reading, hobbies, or driving a car, and lower a patient's quality of life.2 Homonymous visual field defects associated with stroke can recover spontaneously for up to 6 months, and the majority of improvement occurs within a few weeks to 3 months.3 Unfortunately, the rate of spontaneous recovery is only 18% to 72%4 and no effective rehabilitation method exists, which underlines the importance of early recognition and acute therapeutic interventions.
Stroke‐related visual symptoms are often challenging to recognize, for both patients and healthcare professionals, although stroke is the most common cause of homonymous hemianopia.3 Patients may be unaware of the visual field defects7 or confuse them with migraine aura or with ophthalmologic disorders. Posterior circulation (PC) strokes are more frequently misdiagnosed at the emergency department (ED) compared to anterior circulation (AC) strokes,8 and IV thrombolysis may be withheld due to patients' lower National Institutes of Health Stroke Scale (NIHSS) score.9 Moreover, PC strokes appear to accompany a longer prehospital delay10 and door‐to‐needle time11 compared to AC strokes, despite their equally good clinical outcome when treated with IV thrombolysis.14 However, the clinical picture of PC stroke is often dominated by other symptoms and signs, and therefore, studies on PC stroke in general may not be representative of occipital stroke. Although occipital stroke has received relatively little attention, these patients also seem to benefit from IV thrombolysis.16
This single‐center, observational, retrospective, registry‐based study aims to identify the prehospital pathways and delays of occipital strokes presenting with mainly visual symptoms, to investigate obstacles in their recognition, and to determine factors associated with greater delays.

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