![]() Women have a higher lifetime risk and mortality than men, although stroke is more common in men. Individuals who live in the "stroke belt," which predominately involves the Southeast United States, have a 20% higher mortality than those living outside this geographic area. Stroke is currently the third leading cause of mortality in the United States. While the mortality and prevalence of stroke have decreased over the past thirty years, from 40% to 33% in 2013, outcomes vary between populations stratified among race, geography, and comorbidities. Hemorrhagic strokes are commonly caused by aneurysm ruptures, uncontrolled hypertension, arteriovenous malformations, metastasis, amyloid angiopathy. Embolic stroke results from a blood clot or a broken off atherosclerotic plaque, which transverses from one area of the cardiovascular system, eventually occluding a part of the cerebrovascular system. ![]() Thrombotic strokes are caused by excessive atherosclerotic plaque buildup on the arterial wall, which eventually completely occluded the vessel. Lacunar strokes are caused by uncontrolled hypertension, which causes decreased perfusion in small vessels located most commonly in the internal capsule, thalamus, or less frequently, the brainstem. Strokes can be divided into ischemic and hemorrhagic, while ischemic strokes can be further delineated into thrombotic, embolic, and lacunar subtypes. The most common risk factor is hypertension being comorbid in about 70% of patients however, the likelihood of having as troke increases with multiple comorbidities. Hypertension, diabetes mellitus, cigarette smoking, obesity, atrial fibrillation, sedentary lifestyle, hyperlipidemia, illicit drug use such as cocaine, or hypercoagulable states increase the risk of experiencing a stroke. The risk factors of vertebral artery or basal artery stroke are no different from other types of strokes. Stroke is seen as an "end-stage disease" of multiple chronic and uncontrolled comorbidities. The vertebral and basilar arteries are the main blood vessels that supply the brainstem composed of the midbrain, pons, and medulla. These types of strokes require a specialized interdisciplinary team composed of neurologists, radiologists, emergency physicians, specialized nurses, neurosurgeons, and therapists to diagnose, treat, and effectively manage. A brainstem lesion can be localized by observing the presence of "crossed paresis," which is ipsilateral facial paralysis with contralateral limb hemiparesis and cranial nerve deficits. ![]() Patients with sudden interruption of a vertebrobasilar stroke often present with the main complaint of nausea or vertigo, which can delay appropriate neurological evaluation and prevent time-dependent interventions. While these types of strokes are relatively uncommon, they are a disproportionate cause of morbidity and mortality compared to anterior circulation strokes due to discreet symptoms that resemble non-stroke medical conditions. Vertebrobasilar strokes are interruptions of blood flow to the posterior circulation.
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