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Convulsive-Like Movements in Posterior Circulation Large Vessel Occlusion: Associations With Midbrain Injury and Poor
Wan Wang1, Juntao Yin2, Boyi Yuan1
1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
CNS Neuroscience & Therapeutics
|June 13, 2026
Summary
Convulsive-like movements in posterior circulation large vessel occlusion (LVO) are linked to midbrain injury and poor outcomes. Early recognition is crucial for better patient management.
Area of Science:
- Neurology
- Stroke Medicine
- Neurocritical Care
Background:
- Posterior circulation stroke with large vessel occlusion (LVO) can present with uncommon convulsive-like movements.
- These movements are often misidentified as non-epileptic phenomena, and their link to stroke location and prognosis is unclear.
Purpose of the Study:
- To investigate the clinical and imaging features of convulsive-like movements in posterior circulation LVO.
- To determine the association between these movements and functional outcomes.
Main Methods:
- Retrospective analysis of prospectively collected data from 269 patients with posterior circulation LVO.
- Review of neuroimaging for ischemic topography and network involvement.
- Assessment of 90-day functional outcomes using the modified Rankin Scale (mRS) and multivariable logistic regression.
Main Results:
- Convulsive-like movements occurred in 13.0% of patients, associated with more severe neurological deficits and impaired consciousness.
- Midbrain infarction was significantly more frequent in patients with convulsive-like movements (46.4% vs. 19.7%) and independently associated with them.
- Convulsive-like movements were independently associated with poor 90-day functional outcome (aOR, 6.38; 95% CI, 1.38-29.44).
Conclusions:
- Convulsive-like movements in posterior circulation LVO are an underrecognized sign of midbrain injury.
- These movements indicate a higher risk of unfavorable functional outcomes.
- Improved recognition and further validation are warranted.
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