Anterior circulation strokes are commonly considered by emergency physicians, but the signs of posterior stroke can be missed. The session “Posterior Strokes: A Dizzying Differential” will help by raising awareness of the presentation of posterior strokes.
“Posterior circulation strokes can present in a subtler manner than anterior circulation strokes,” said Rachel E. Garvin, MD, emergency physician and neurointensivist at the University of Texas Health Science Center in San Antonio. “As emergency medicine providers, we know to call a stroke alert for the patient presenting with gaze preference and hemiplegia, but nausea, vomiting, and dizziness usually don’t prompt that line of thinking.”

Dr. Garvin’s session will use a step-by-step approach to review the clues to help pick up posterior circulation stroke. For instance, she’ll talk about the association between feeling weak and dizzy and a posterior stroke. “Feeling weak and dizzy are common chief complaints, but in older patients or patients with stroke factors, a good history and physical exam are crucial when patients present with those symptoms,” she said.
Dr. Garvin also will address the importance of a thorough neurologic exam to pick up subtle weakness or cranial nerve findings. “Cranial nerve exam is key for posterior circulation strokes as unless you just hit the cerebellum, there will be cranial nerve findings,” she said.

However, the neurologic exam does not need to be time-consuming. “This doesn’t necessarily mean you need to take 30 minutes to examine the patient,” she said. “We will go over the anatomy and physiology of the posterior circulation so you will have the knowledge to know where to focus that all-important physical exam.”