My interest in posterior circulation vascular disease was stimulated early during my stroke fellowship in 1969, by an encounter with a patient who developed cortical blindness, severe agitation, and loss of memory while in the hospital. Later during that year, under the tutelage of Dr. C. Miller Fisher I thoroughly studied and reported eye movement abnormalities in patients with midbrain and thalamic infarcts and ptosis among stroke patients. Ever since then I have been fascinated by the plethora of symptoms and signs that develop in patients with lesions within the brain structures fed by posterior circulation vessels, a territory that makes up less than a quarter of the volume of the brain. I have made the study of neurological phenomena attributable to vascular-related injury to this territory and to clinical posterior circulation disease the focus of my life’s work. This monograph on disease of the posterior circulation represents my “magnum opus.” I am a devotee of medical history.
I do not believe that one can conjure up a path to the future, or even estimate where one is now, without knowing the past developments and ideas and how they evolved. For that reason I have included a chapter on history, and began each chapter with historical developments in the topic covered by the chapter. The first edition was published in 1996, at a time when I did not have available some of the final results in the New England Medical Center – Posterior Circulation Registry (NEMC-PCR). This registry included over 400 thoroughly studied patients and was and is the largest accumulation of patients with ischemic posterior circulation disease.