Etiopathogenesis and predictors of in-hospital morbidity and mortality in posterior circulation strokes--a 2 year registry with concordant comparison with anterior circulation strokes.

AIMS To determine etiopathogenetic factors, predictors of in-hospital morbidity and mortality, and discharge status in a serially recruited cohort of PCS patients at a tertiary care hospital. Comparison of data between ACS and PCS groups was also done. METHODS Seventy six cases of PCS and 108 cases of ACS were serially recruited, within 48 hrs of stroke onset, over a 2 year period. Vascular territory determination, stroke subtype and classification, risk factor profile and outcome measures were determined. RESULTS 77.6% of PCS strokes were ischemic in origin. A cardioembolic source was seen in 12/29 (42%) PCS cases. Intraarterial cause was seen in 5/29 (17.2%) PCS cases. 22.3% of PCS and 24% of ACS patients developed dysphagia. Pneumonia developed in 70% and 65% of dysphagic patients in PCS and ACS groups respectively. Mortality in PCS group was 14/76 (18%) and in ACS group 17/108 (15.7%). The principal contributory factors to mortality in PCS were low Glasgow coma score at presentation, development of respiratory morbidity, and vascular lesions in 'middle plus distal' territory. At discharge, 62% PCS patients were in group 2-3 of modified Rankin scale and 64% of ACS patients were in group 3-4. CONCLUSIONS A cardiac source of distal territory infarct was significantly commoner in PCS as compared to ACS. Incidence of post-stroke complications, viz. dysphagia, pneumonia, deep venous thrombosis, bed-sores and urinary infection, was comparable in the two groups. Dysphagia, seen in 22% PCS and 24% of ACS, was the principal causation of pneumonia. Mortality and disability status at discharge were comparable in the 2 groups.