Symptoms and signs of perfusion disturbances in vertebrobasilar territory
1. Big picture
Vertebrobasilar perfusion disturbance means ischemia in the posterior circulation, supplied mainly by the vertebral arteries, basilar artery, and their branches. Clinically, this is very important because posterior circulation stroke can be missed easily, especially when the first complaint is only vertigo, nausea, diplopia, gait instability, or dysarthria.
For the exam, remember the simple contrast:
| Territory | Typical pattern |
|---|---|
| Carotid / anterior circulation | cortical signs, aphasia, neglect, face-arm weakness, visual field defect |
| Vertebrobasilar / posterior circulation | brainstem signs, cranial nerve signs, cerebellar signs, crossed deficits, impaired consciousness |
In the lecture material, posterior circulation stroke is presented as about 20% of ischemic strokes, while carotid territory stroke is about 80%, so the carotid : vertebrobasilar ratio is 4 : 1.
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