الفهرس 
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Abstract
Posterior circulation stroke is a neurological emergency associated with complex and fluctuating symptomatology. Diagnosis of posterior circulation stroke and transient ischemic attack can be more interesting than anterior circulation due to the enormous area of brain tissue supplied by the posterior circulation and, as a consequence, the wide range of frequently non-specific symptoms. Management of PCS had been difficult due to misdiagnosis, delay pre-hospital time, false neuroimaging, and lower accuracy of Current clinical scales in the measurement of posterior stroke severity. This led to poor prognosis, high mortality, and a recurrence rate. This work aimed to estimate clinical, laboratory, and radiological aspects of posterior circulation stroke and functional outcomes in patients who will be admitted to the Stroke Unit of the Neuropsychiatry Department, Tanta University Hospitals. This work was a prospective cohort longitudinal study conducted on 152 acute posterior circulation stroke patients documented by clinical presentation, cranial non-contrast computed tomography (NCCT), and/or brain magnetic resonance imaging (MRI). They attended the neurology emergency room (ER) at the Department of Neuropsychiatry and Center of Neurology and Psychiatry, Tanta University Hospitals over the period between April 2022 to 1st October 2022. Included patients were followed-up in monthly visits for 3 months post-discharge. The study included 119 posterior ischemic stroke patients (PCIS) and 33 posterior fossa hemorrhage patients. Patients received early stroke management regarding the 2018 AHA/ASA guideline and its 2019 update. Exclusion criteria encompassed Patients had subarachnoid hemorrhage. Patients with concomitant anterior circulation occlusion are suspected on a clinical base and/or proven on vascular imaging. Stroke mimics and global cerebral dysfunction (PRESS, encephalopathy, etc.). Included patients were submitted to: 1. History taking and neurological examinations. 2. Stroke severity assessment using the National Institutes of Health Stroke Scale (NIHSS). 3. Emergency laboratory investigations. 4. Routine Laboratory investigations. 5. Other laboratory investigations when indicated included: i. Hypercoagulable state biomarkers such as protein C, S, factor V Leiden, antithrombin III. ii. Markers of autoimmune disorders like ESR, antinuclear antibody (ANA), anti-double strand (Anti ds DNA), antiphospholipid antibody (APL), lupus erythematous cell test, anticardiolipin Ab, rheumatoid factor Ab. 6. Radiological investigations i. Non-contrast Computed tomography brain and CT angiography (cranial and cervical) ii. Magnetic resonance imaging brain for CT brain-free patients iii. Cervical and transcranial Doppler and duplex iv. Cervical and Cerebral Vessel Imaging: Cerebral/cervical magnetic resonance angiography and magnetic resonance venography (to exclude patients with cerebral sinus thrombosis). 7. Cardiac imaging and evaluation for a possible cardiac source of emboli which included the following (routine ECG, long-term ECG monitoring, transthoracic and transesophageal echocardiogram). The patients were admitted using the following scales at admission and follow-up: including Glasgow Coma Score and National Institute of Health Stroke Scale (NIHSS), Adam’s scale of posterior circulation ischemic stroke (ASPCS), and intracerebral hemorrhage severity for patients with posterior circulation hemorrhage (ICH score), and Advanced activity of daily living scale (AADLs). Stroke was classified according to the TOAST classification into a large artery, small artery, and cardiogenic, other determined, undetermined, and dnnnureend-rednu strokes. The patients were followed after discharge every month at regular visits for three months through a modified Rankin scale. The results of the present study revealed the following: Regarding PCIS 1. PCIS had a mean age range of (35-86) mean (63), 66 males represent 55 %, 64 patients had DM (54%), 67 patients had HTN (56%), 37 patients had IHD (31%),22 patients were AF (18%), 53 patients were smoker (45%), 30 patients had previous stroke (25%), 20 patients had covid 19 infection (17%). 2. GCS of studied patients were (3-15) Mean (13), NIHSS (1-27) Mean (8), and ASPCS (1-15) Mean (5.5). 3. The number of PCIS patients was 119 (20%) of total ischemic patients came to ER 4. The clinical picture of PCIS patients showed that limb weakness in 72 patients (61.02%) is the most symptom, then vertigo in 46 patients (39%) followed by ataxia in 35 patients (29.66%) then DCL in 27 patients (22.88%). 5. The distribution of studied PCIS according to TOAST classification to large artery 60 patients (50.42%), cardioembolic 25 patients (21.84%), small artery disease 22 patients (18.48%) Undetermined 8 patients (6.72%), other determined 3 patients (2.52%) and underdetermined 3 patients (2.52%). 6. Neuroimaging: superiority of DWI-PC-ASPECTS in the detection of infarction in initial ER evaluation. 7. The middle segment is the most occluded in 49 patients (42%) then the distal segment in 39 patients (32%) and the proximal segment in 30 patients (26%). 8. 16 patients (13.45%) patients took r-tPA from total PCIS patients 9. The number of patients who had unfavorable MRS (0-2) was 83 patients (70%) while favorable MRS represent 36 patients (30%). 10. Positive significant correlation between the age, NIHSS, ASPCS, and SBP of PCIS patients and modified Rankin scale. Negative significant correlation between DWI-pc-ASPECTS, GCS, and AADLs of PCIS patients and modified Rankin scale. 11. PCIS patients had a lower NIHSS mean (8) than ACIS mean (12). 12. PCIS had milder weakness than ACIS dispropriate for ataxia. 13. Fast negative symptoms (vertigo (39%), ataxia (30%), headache (22%), visual field affection (10%), and disturbed conscious level (23%) are more in PCIS while limb weakness (88%) and language affection (65%) are more in ACIS. 14. Significant difference in the type of stroke in studied patients. 15. A significant decrease in receiving r-tPA in PCIS patients16 (13.56%) compared to ACIS patients 155(31.63%). Regarding posterior fossa hemorrhage 1. 33 patients had posterior fossa hemorrhage Age range of (45-88) with a mean of (68), 21 were male (64%), 29 patients had HTN (88%) 2. GCS range (3-15) Mean (10), NIHSS range (2-27) Mean (13.500), ICH SCORE (1-5) Mean (2.6). 3. Clinical presentation of posterior fossa hemorrhage at ER showing that vertigo was the most common symptom in 20 patients (60.60%) followed by DCL in 16 patients (48.48%) then weakness in 14 patients (42.42%), ataxia in 12 patients (36.36%) 4. Initial clinical picture of PCIS and posterior fossa hemorrhage patients indicating DCL and vertigo had a significant increase in posterior fossa hemorrhage patients compared to PCIS patients 5. Distribution of PFH patients etiologically to 27 patients were due to HTN (82%), then amyloid angiopathy in 2 patients (6%), medication (warfarin toxicity) in 2 patients (6%), 1 patient had systemic diseases (renal failure) (3%), and 1 patient had structural vascular anomaly (arteriovenous malformation) (3%) 6. Distribution of posterior fossa hemorrhage patients according to the site of hemorrhage showing cerebellar hemorrhage in 16 patients (48%) then pontine in 8 patients (24%), then thalamic in 6 patients (18%), and midbrain in 3 patients (9%) 7. The number of patients who had favorable MRS (0-2) was 15 patients (45%) while unfavorable MRS represent 18 patients (55%). 8. Positive significant correlation between the ICH score scale, NIHSS of Posterior fossa hemorrhage patients, and modified Rankin scale. Negative significant correlation between Age, AADL, and SBP of PFH patients and modified Rankin scale.