1/Do you know all the aspects of, well, ASPECTS?
Many know the anterior circulation stroke scoring system—but posterior circulation (pc) ASPECTS is often left behind
25% of infarcts are posterior circulation
Do you know pc-ASPECTS?!
Here’s a 🧵to help you remember pc-ASPECTS
Many know the anterior circulation stroke scoring system—but posterior circulation (pc) ASPECTS is often left behind
25% of infarcts are posterior circulation
Do you know pc-ASPECTS?!
Here’s a 🧵to help you remember pc-ASPECTS
2/Many know anterior circulation ASPECTS.
It uses a 10-point scoring system to semi-quantitatively estimate the amount of the MCA territory infarcted on non-contrast head CT
If you need a review: here’s my thread on ASPECTS:
It uses a 10-point scoring system to semi-quantitatively estimate the amount of the MCA territory infarcted on non-contrast head CT
If you need a review: here’s my thread on ASPECTS:
3/But it’s only useful for the anterior circulation.
Posterior circulation accounts for ~25% of infarcts.
Even w/recanalization, many do poorly bc of the extent of already infarcted tissue
So there’s a need to quantitate the amount of infarcted tissue in these pts
Posterior circulation accounts for ~25% of infarcts.
Even w/recanalization, many do poorly bc of the extent of already infarcted tissue
So there’s a need to quantitate the amount of infarcted tissue in these pts
4/Like traditional ASPECTS, pc-ASPECTS is also a 10 point system—but for the vertebrobasilar circulation.
Patients gets points for each region NOT infarcted on the initial CT.
Patients gets points for each region NOT infarcted on the initial CT.
5/Similar to anterior ASPECTS, points are GOOD.
It’s like a city—when a region infarcts, it is like the lights go out in that city region (literally, tissue darkens on CT)
In ant & post ASPECTS, you are counting the regions where the lights are still on—so high ASPECTS is good
It’s like a city—when a region infarcts, it is like the lights go out in that city region (literally, tissue darkens on CT)
In ant & post ASPECTS, you are counting the regions where the lights are still on—so high ASPECTS is good
6/Which regions get scored?
The biggest prognostic factors in posterior strokes are time & amount of already infarcted tissue.
So my mnemonic to remember pc-ASPECTS regions is:
Time & Mortal Brain decide Posterior Circulation Outcomes
(mortal brain= infarcted brain)
The biggest prognostic factors in posterior strokes are time & amount of already infarcted tissue.
So my mnemonic to remember pc-ASPECTS regions is:
Time & Mortal Brain decide Posterior Circulation Outcomes
(mortal brain= infarcted brain)
7/How do you assign the points?
It’s a little different than anterior ASPECTS, where every region just got one point
For pc-ASPECTS, think of it like a mother.
She only has 2 arms
So if there are 2 kids, they have to split the arms—only one arm can be wrapped around each kid
It’s a little different than anterior ASPECTS, where every region just got one point
For pc-ASPECTS, think of it like a mother.
She only has 2 arms
So if there are 2 kids, they have to split the arms—only one arm can be wrapped around each kid
8/So unpaired structures, like the brainstem, are like having only one kid—you get both arms wrapped around you = 2 arms = 2 points.
If the structures are paired, like the cerebellum, it’s like having two kids, they must split the arms. Each gets 1 arm = 1 point
If the structures are paired, like the cerebellum, it’s like having two kids, they must split the arms. Each gets 1 arm = 1 point
9/So lets go through our regions using the mnemonic.
Each thalmus is worth only 1 point, bc they’re paired & have to share their mother’s arms.
The unpaired midbrain is worth 2 points
Each thalmus is worth only 1 point, bc they’re paired & have to share their mother’s arms.
The unpaired midbrain is worth 2 points
10/Pons is unpaired, so it is worth 2 points.
But the paired cerebellar hemispheres & occipital cortex are each only worth 1 point, as each side claims only one of the mother’s arms
But the paired cerebellar hemispheres & occipital cortex are each only worth 1 point, as each side claims only one of the mother’s arms
11/While there’s evidence that a bad pc-ASPECTS means poorer outcome, there’s no consensus about what pc-ASPECTS score definitively confers a UFO (unfavorable outcome).
But the consensus about what confers a UFO in anterior circulation ASPECTS is constantly changing as well!
But the consensus about what confers a UFO in anterior circulation ASPECTS is constantly changing as well!
12/So now you know the regions & scoring for pc-ASPECTS!
Remember, the anterior circulation isn’t the only aspect of ASPECTS!
Don’t let the scoring system for the BACK of the arterial system get left BEHIND!
Remember, the anterior circulation isn’t the only aspect of ASPECTS!
Don’t let the scoring system for the BACK of the arterial system get left BEHIND!
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