Synopsis
Recognise vertebrobasilar stroke beyond FAST, localise brainstem, cerebellar and occipital syndromes, and obtain urgent vascular and tissue imaging for reperfusion and swelling management.
- Posterior circulation stroke can present with diplopia, dysarthria, dysphagia, vertigo, nystagmus, ataxia, visual field loss, crossed sensory findings or reduced consciousness and may be FAST-negative.
- Basilar artery occlusion can fluctuate or progress to quadriparesis, coma or locked-in syndrome and requires immediate CTA and thrombectomy-centre discussion.
- Isolated dizziness is usually not stroke, but an acute continuous vestibular syndrome with inability to stand, central eye signs, new headache or focal neurology demands urgent expert assessment.
Key red flags
Reduced consciousness, bilateral weakness, new respiratory irregularity or rapidly evolving cranial-nerve signs suggests basilar occlusion or brainstem compression and needs immediate airway and thrombectomy-centre escalation.
Investigation priorities
Exclude intracranial haemorrhage and detect a large established posterior infarct, hydrocephalus or another structural lesion.
Management branches
New continuous vertigo, nausea, nystagmus and gait unsteadiness persist for hours rather than brief positional spells.
- Check glucose and observations and examine pupils, ocular alignment and movement, nystagmus, cranial nerves, speech, limbs, coordination and ability to sit or stand safely.
- Use HINTS only if trained and the patient meets its intended syndrome; any central sign or unresolved high-risk presentation needs urgent stroke assessment.
The posterior circulation infarct is stable after acute reperfusion and complication decisions.