History of Vertebrobasilar Territory Stroke and TIA

The posterior circulation territory was initially of interest to physicians because it contained the brainstem. Clinical–anatomical correlations educated doctors as to how the brainstem functioned. Brainstem, cerebellar, and occipitotemporal lobe anatomy and the anatomy of the vertebral and basilar arteries were clarified during the nineteenth and early twentieth centuries. It was not until the 1920s that Charles Foix stimulated interest in the causes and mechanisms of occlusion of the brain-supplying arteries. When CT and later MRI became available, it was possible to perform more accurate clinical–anatomical–pathological studies of patients with infarcts and hemorrhages within the posterior circulation territories. When CT, MR, and digital subtraction angiography became widely available, physicians could then correlate occlusive disease involving the vertebral and basilar arteries with the usual locations of brain ischemia and the associated clinical features. The epidemiology and causes of vascular lesions could also be better studied than in the past. Modern studies clarified the causes, frequency, and locations of various vertebral and basilar artery lesions and the usual distribution of brain ischemia, infarction, and hemorrhage within posterior circulation territories.