The neurosurgical implications of PICA strokes

If your big PICA stroke gets worse, there are plenty of possible causes – here is a list:

  1. Direct brainstem compression
    – typically affects the contralateral corticospinal tract, often above it’s crossin, so that an ipsilateral hemiparesis occurs
    – pontomedullary motor cranial nerves might be affected
    – vertigo, oculomotor abnormalities
  2. Hydrocephalus from
    – Compression of the IIIrd ventricle
    – Compression of the aqueduct
    – Compression of the IVth ventricle
  3. Ascending transtentorial herniation
    – Somnolence
    – Vertical oculomotor abnormalities
    – Vertigo
  4. Transforaminal herniation
    – Vertigo
    – Nystagmus
    – Medullary brainstem signs

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