Symptoms and signs take center stage during the clinical encounter. They provide the basis for clinical diagnosis. Separation of transient and persistent brain ischemia from other neurological causes as well as localization of the findings to the anterior or posterior circulation are based on symptoms and signs and are important to effectively plan brain and vascular imaging and other investigations. Past estimates of the frequency, sensitivity, and specificity of various clinical findings in patients suspected of having vertebrobasilar occlusive disease were not based on documentation of posterior circulation infarction. In some early series, the diagnosis of vertebrobasilar disease was not confirmed by angiography or other vascular imaging.
1-4 In other series, symptoms and signs were reported in patients with specific subtypes of posterior circulation ischemic disease (eg, basilar artery occlusion, lateral medullary infarction, cerebellar infarction). More recently, a prospective study of 116 patients with posterior circulation ischemia from Qatar was published.
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