The National Institutes of Health Stroke Scale (NIHSS) is not robust for patients with posterior circulation strokes due to lack of inclusion of common signs and symptoms. We assessed the frequency of gait abnormality in the initial evaluation of a posterior circulation stroke. We suspected that the frequency of gait abnormality in posterior circulation stroke would exceed that of other posterior signs and symptoms. 

In this retrospective case series, we identified patients with acute, imaging-confirmed, posterior circulation stroke (posterior cerebral, basilar, and vertebral artery territories) using the Get With the Guidelines database at NYU Langone Hospital. We specifically compared the frequency of patients with gait abnormality, defined as objective documentation of unsteadiness with regular or tandem gait, to those with other posterior signs and symptoms.

Of the 152 patients with confirmed posterior circulation stroke, 91 presented acutely with strokes unique to the posterior circulation territory. The average age of patients was 66.8 and average NIHSS was 3.42. Of the 80 patients assessed for gait, 68 (85%) had gait abnormality. In patients with posterior circulation stroke, gait abnormalities were 1.58x (68/80 vs 49/91) more frequent than dizziness, 2.34x (68/80 vs 33/91) more frequent than nausea/vomiting, 2.50x (68/80 vs 31/91) more frequent than dysarthria, 3.36x (68/80 vs 23/91) more frequent than dysmetria, 4.83x (68/80 vs 16/91) more frequent than nystagmus, and 5.53x (68/80 vs 14/91) more frequent than vision changes.

Gait abnormality was the single most frequent sign or symptom in patients with posterior circulation stroke on acute presentation. Further prospective trials are warranted to determine if gait abnormality is predictive of posterior circulation stroke. It is imperative to regularly perform adequate gait assessments as part of acute stroke evaluations, especially when posterior circulation stroke is suspected.