To discuss the clinical impact of stroke. To address imaging exam choices for posterior circulation stroke and their performance metrics. To discuss evolving paradigms in the detection and management of posterior circulation stroke. To apply this information using sample cases.

Stroke is associated with significant morbidity and mortality, with recent estimates of approximately 800,000 new cases in the United States alone and up to 16.9 million new cases of stroke worldwide. While the overall mortality due to stroke appears to be decreasing in the United States, it remains a leading cause of death. According to updated American Heart Association statistics, stroke accounted for almost 5% of all deaths in the United States and was the 5thleading cause of death when considered separately from other etiologies...

Prompt diagnosis of posterior circulation (PC) stroke is essential. Patients treated within the “stroke window” with thrombolysis may demonstrate improved neurologic outcomes. Common imaging paradigms for suspected stroke in either the anterior or posterior circulation consist of non-contrast computed tomography of the head to exclude intracranial hemorrhage, as well as CT angiography (CTA) to evaluate for the presence of large vessel occlusion (LVO). CTA findings are a key factor in determining which patients are eligible for mechanical thrombectomy, while additional data from CT perfusion aids...

While PC stroke only represents one-quarter of stroke cases, it bears high morbidity and mortality. Symptoms are nonspecific and can be difficult to recognize. Studies suggest that most PC strokes are missed at the first point of healthcare contact, which may result in missed opportunities for thrombolysis/thrombectomy and risk factor optimization. This can lead to death or significant disability, which affects the patient’s quality of life and has been associated with increased healthcare costs. Therefore, it is important for clinicians to be aware of the...

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