Vertebrobasilar infarctions: principles of classification, clinical and neuroimaging analysis and terminological definitions of the diagnosis

Abstract

The aim — to describe the neurological clinic, specific symptoms and syndromes in patients with acute infarction of various anatomical and vascular territories of the posterior circular pool, to justify the use in clinical practice of the terminological formulation of the diagnosis which will reflect the affected intracranial vascular territory of the posterior circulation, localization of the infarction center and its clinical version. Materials and methods. A comprehensive clinical, neurological and neuroimaging examination of 120 patients with acute infarction of various areas of the posterior circular pool was performed. The localization and size of the infarction focus, the dynamics of the degree of impairment of neurological functions, the upset of daily vital activity, the degree of social maladjustment of patients were assessed. Results and discussion. The features of the neurological clinic of lacunar and non‑lacunar infarctions are described depending on the affected intracranial territory of the posterior circular pool. The significance in clinical practice of the terminological formulation of the diagnosis is substantiated. Conclusions. In the event of ischemic infarction in different parts of the brain stem or the cerebellum, it is not appropriate to formulate the diagnosis as «ischemic stroke in the vessels of the vertebrobasilar basin», since it only partially reveals the essence of the stroke. In case a medullary, bridging, mesencephalic, cerebellar or thalamic infarction develops, it is methodologically justified and adequate to use the terminological formulation of the diagnosis which will reflect the damaged vascular territory (proximal, median, distal), the clinical variant of the infarction and the anatomical‑topographic localization of the damaged posterior circular pool, and brain stem isolated or connected to other intracranial territories. Knowledge of the features of the neurological clinic and the modern terminological definition of the diagnosis of infarctions in the vertebrobasilar basin is important for the practitioner, the choice of adequate therapies and the assessment of the long‑term functional prognosis.