Relationship between the clinical manifestations and prognosis of posterior circulation stroke： a prospective case series study

Objective To investigate the major clinical manifestations and their effect on prognosis in patients with posterior circulation stroke （PCS）. Methods The clinical data of 129 consecutive hospitalized patients with acute PCS confirmed by clinical and imaging were registered prospectively, and they were followed up for 3 haonths. The patients were divided into a good prognosis group （modified Rankin scale [ mRS] score ≤ 2） and a poor prognosis group （mRS score ≥ 3） according to their mRS scores. Results 90. 7% patients had 4 to 12 symptoms and signs, only 1 presented an isolated symptom. The most common symptoms and signs were unilateral. Crossed paralysis （1.6%） or quadriplegia （0. 8% ） was rare. Univariate analysis showed that the symptoms of unilateral limb weakness （relative risk [RR] 1. 262, 95% confidence interval [ CI] 1. 030 - 1. 546; P=0. 030）, slurred speech （RR 1.434, 95%CI 1. 133 - 1.816; P= 0. 004）, dysphagia （RR 2. 216,95%CI 1. 131 -4. 341; P=0. 017）, and the signs of decreased unilateral muscle strength （RR 1. 288, 95%CI 1. 047 - 1. 583; P = 0. 021 ）, central facial/tongue paralysis （RR 1. 467, 95% C1 1. 164 - 1. 850; P = 0. 002）, dysarthria （RR 1. 468, 95% CI 1. 154 - 1. 867; P = 0. 002）, ocular motor dysfunction （RR 3.073, 95% CI 1. 346 -7. 017; P=0. 005）, and conscious disturbance （RR 5. 736, 95%CI 1. 268 -25. 946; P=0. 023） were the risk factors for poor prognosis, while ataxia （RR 0. 478, 95% CI 0. 284 - 0. 804; P =0. 002） was associated with good proguosis. Multivariate logistic reffession analysis demonstrated that after adjusted for all risk factors, the baseline National Institutes of Health Stroke Scale （NIHSS） （odds ratio [ OR ] 1.513, 95% CI 1. 107 - 2. 066; P = 0. 009）, dysarthria （OR, 7. 11, 95% CI 1. 207 - 41. 877; P = 0. 030）, ocular motor dysfunction （OR 8. 653, 95% CI 1. 230 - 60. 887; P = 0. 030）, and large-artery atherosclerotic stroke （OR 5. 482, 95% CI 1. 008 -29. 803; P =0. 049） were the independent risk factors for poor prognosis in patients with PCS, while ataxia （OR 0. 251, 95% CI 0. 067 - 0. 941; P = 0. 040） was independently associated with good prognosis of the patients. Conclusions The clinical manifestations in patients with PCS are complex, the majority of their symptoms and signs are unilateral. Most of the patients showed a variety of symptoms, and the isolated symptoms are rare. Some symptoms and signs may indicate the prognosis of patients.