What is included in the monitoring of patients following a posterior cerebral artery (PCA) stroke?

Updated: Jul 30, 2018
  • Author: Erek K Helseth, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Patients who have had a posterior cerebral artery (PCA) stroke should be observed on an outpatient basis to ensure that cerebrovascular risk factors are treated chronically, that changes in medication management following stroke are well tolerated, and that chronic disability is appropriately addressed.

Attention to rehabilitation should begin early. Involvement of a speech-language therapist may be required if alexia is present, with or without aphasia. An occupational therapist should be able to help teach patients to turn in order to view a blank visual hemifield.

An issue that frequently arises with infarction of the visual cortex or its afferent fibers is patient competency to drive a vehicle. Patients with infarction in the territory of the left PCA may have preserved macular vision but severe restriction of peripheral vision, as well as an inability to read in any visual field. Patients with infarction in the territory of the right PCA may have significant visual hemineglect.

Careful examination of the patient and knowledge of local laws governing the right to drive are a necessity. Repeated visual-field testing is required (some recovery of vision may occur), as well as further assessment by occupational therapists and clinicians.

Patients often have to relinquish their driver’s license because of the visual field loss. This may result in considerable loss of independence and provoke anger and grief in the patient, for which counseling may be required.

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