Non-convulsive seizure clustering misdiagnosed as vertebrobasilar insufficiency

✓ A long-term follow-up study (minimum duration 2 years) was made of 13 patients with tortuous dilated basilar arteries. Of these, five patients had symptoms related to the presence of such arteries. Symptoms present at a very early stage included vertebrobasilar insufficiency in two patients, brainstem infarction in two patients, and left hemifacial spasm in one patient. Initial magnetic resonance (MR) imaging in serial slices of basilar arteries obtained from the five symptomatic patients showed an intimal flap or a subadventitial hematoma, both of which are characteristic of a dissecting aneurysm. In contrast, the basilar arteries in the eight asymptomatic patients did not show particular findings and they remained clinically and radiologically silent during the follow-up period. All of the lesions in the five symptomatic patients gradually grew to fantastic sizes, with progressive deterioration of the related clinical symptoms. Dilation of the basilar artery was consistent with hemorrhage into the “pseudolumen” within the laminated thrombus, which was confirmed by MR imaging studies. Of the five symptomatic patients studied, two died of fatal subarachnoid hemorrhage (SAH) and two of brainstem compression; the fifth patient remains alive without neurological deficits. In the three patients who underwent autopsy, a definite macroscopic double lumen was observed in both the proximal and distal ends of the aneurysms within the layer of the thickening intima. Microscopically, multiple mural dissections, fragmentation of internal elastic lamina (IEL), and degeneration of media were diffusely observed in the remarkably extended wall of the aneurysms. The substantial mechanism of pathogenesis and enlargement in the symptomatic, highly tortuous dilated artery might initially be macroscopic dissection within a thickening intima and subsequent repetitive hemorrhaging within a laminated thrombus in the pseudolumen combined with microscopic multiple mural dissections on the basis of a weakened IEL. The authors note and caution that symptomatic, tortuous dilated basilar arteries cannot be overlooked because they include a group of malignant arteries that may grow rapidly, resulting in a fatal course.

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Surgical Treatment of Patients with Symptomatic Vertebrobasilar Insufficiency

Annals of Vascular Surgery ◽

10.1007/s100169900111 ◽

1998 ◽

Vol 12 (1) ◽

pp. 28-33 ◽

Cited By ~ 9

Author(s):

Boulous Toursarkissian ◽

Brian G. Rubin ◽

Jeffrey M. Reilly ◽

Robert W. Thompson ◽

Brent T. Allen ◽

...

Keyword(s):

Surgical Treatment ◽

Vertebrobasilar Insufficiency

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Intracranial Vertebral Endarterectomy

Neurosurgery ◽

10.1227/00006123-199003000-00014 ◽

1990 ◽

Vol 26 (3) ◽

pp. 465-471 ◽

Cited By ~ 22

Author(s):

James I. Ausman ◽

Fernando G. Diaz ◽

Balaji Sadasivan ◽

Manuel Dujovny

Keyword(s):

Vertebral Artery ◽

Medical Therapy ◽

Superficial Temporal Artery ◽

Posterior Inferior Cerebellar Artery ◽

Temporal Artery ◽

Superior Cerebellar Artery ◽

Focal Lesion ◽

Cerebellar Infarction ◽

Vertebrobasilar Insufficiency ◽

Cerebellar Artery

Abstract Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA). In this group, after endarterectomy, the vertebral artery was patent in two patients, and their symptoms resolved: in one patient the endarterectomy occluded, but the patient's symptoms improved; and in one patient the endarterectomy was unsuccessful, and he continued to have symptoms. In one patient, the plaque was at the origin of the PICA. The operation appeared technically to be successful, but the patient developed a cerebellar infarction and died. In one patient the stenosis was distal to the PICA. During endarterectomy, the plaque was found to invade the posterior wall of the vertebral artery. The vertebral artery was ligated, and the patient developed a Wallenburg syndrome. The results of superficial temporal artery to superior cerebellar artery anastomosis are better than those for intracranial vertebral endarterectomy for patients with symptomatic intracranial vertebral artery stenosis. The use of intracranial vertebral endarterectomy should be limited to patients who have disabling symptoms despite medical therapy, a focal lesion proximal to the PICA, and a patent posterior circulation collateral or bypass.

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Clinical Diagnosis of Vertebrobasilar Insufficiency: Resident's Case Problem

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2005.35.10.645 ◽

2005 ◽

Vol 35 (10) ◽

pp. 645-650 ◽

Cited By ~ 16

Author(s):

Skulpan Asavasopon ◽

John Jankoski ◽

Joseph J. Godges

Keyword(s):

Clinical Diagnosis ◽

Vertebrobasilar Insufficiency

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Atlanto-Occipital Decompression of Vertebral Artery for a Variant of Bow Hunter's Syndrome: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab231 ◽

2021 ◽

Author(s):

Nickalus R Khan ◽

Turki Elarjani ◽

Stephanie H Chen ◽

Laszlo Miskolczi ◽

Sheryl Strasser ◽

...

Keyword(s):

Vertebral Artery ◽

Rare Condition ◽

Head Rotation ◽

Treatment Modalities ◽

Spinal Instability ◽

Vertebrobasilar Insufficiency ◽

Common Etiology ◽

Neurologically Intact ◽

Hunter's Syndrome ◽

Visual Abnormalities

Abstract Rotational vertebral artery (VA) occlusion syndrome, also known as bow hunter's syndrome, is an uncommon variant of vertebrobasilar insufficiency typically occurring with head rotation.1-3 The most common presenting symptom is dizziness (76.8%), followed by visual abnormalities and syncope (50.4% and 40.4%, respectively).2 Osteophytic compression due to spinal spondylosis has been shown to be the most common etiology (46.2%), with other factors, such as a fibrous band, muscular compression, or spinal instability, being documented.1,2 Treatment is dependent on the level and site of VA compression with anterior, anterolateral, or posterior approaches being described.1,4 We present the case of a 72-yr-old male with osteophytic compression of the V3 segment of the vertebral artery at the occipital-cervical junction. The patient underwent a C1 hemilaminectomy and removal of osteophytic compression from the occipital-cervical joint. The patient had complete resolution of compression of his vertebral artery on postoperative imaging and remained neurologically intact following the procedure. We review the literature on this topic, the technical nuances of the procedure performed, and review the different treatment modalities available for this rare condition.1-11 The patient consented to the procedure and to publication of their image.

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Cerebral Blood Flow Volume in Posterior Circulation Ischemic Disorders

Journal for Vascular Ultrasound ◽

10.1177/15443167211053911 ◽

2021 ◽

pp. 154431672110539

Author(s):

Anastasiya Yu. Vishnyakova ◽

Nataliya M. Medvedeva ◽

Alexander B. Berdalin ◽

Svetlana E. Lelyuk ◽

Vladimir G. Lelyuk

Keyword(s):

Blood Flow ◽

Healthy Volunteers ◽

Internal Carotid ◽

Duplex Sonography ◽

Posterior Circulation ◽

Control Group ◽

Vertebrobasilar Insufficiency ◽

Flow Volume ◽

Blood Flow Volume ◽

Vertebral Arteries

Objective: The aim of this study was to determine blood flow volume (BFV) in the normal state and its features in patients with acute posterior circulation ischemic strokes (PCIS) and vertebrobasilar insufficiency (VBI) using color duplex sonography (DS).Methods: The study included DS data from 96 patients with verified PCIS (66 men and 30 women, aged 64±13 years) and 29 adults with VBI (17 men and 12 women, aged 66±11 years). The control group consisted of 65 healthy male volunteers of different ages.Results: In asymptomatic healthy volunteers, there was a significant decrease in BFV in the internal carotid artery (ICA) with age (502 ml/min in young people, 465 ml/min in the older subgroup) with rS = −0.24 ( p = 0.05), and the aggregated BFV in the vertebral arteries (VAs) turned out to be almost constant (141–143 ml/min). In patients with VBI, the aggregated BFV in the VAs (144 ml/min) did not differ from that in healthy volunteers, but the BFV values in the ICAs were significantly lower (325 ml/min). In patients with PCIS, the aggregated BFV in the ICAs was also significantly lower (399 ml/min) than in the control group but did not significantly differ from that in patients with VBI. In patients with PCIS, there was a significant decrease in the aggregated BFV in the VAs (105 ml/min), which distinguished this group from other examined patients.Conclusions: A significant decrease the BFV in the VA was observed only in patients with PCIS and was associated with the presence of steno-occlusive diseases (SOD) more often in the left VA. Patients with VBI had the most pronounced decrease in BFV in the ICA.

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A case of hysterical deafness

Kazan medical journal ◽

10.17816/kazmj46871 ◽

1901 ◽

Vol 1 (7-8) ◽

pp. 392-392

Author(s):

N. Yu. Kumberg

Keyword(s):

Joint Action ◽

Convulsive Seizure ◽

Physical Fatigue ◽

Physical Trauma

Abstracts. Psychiatry.Dr. N. Yu. Kumberg. A case of hysterical deafness. Doctor. 1901, No. 19.A man under the influence of joint action for a number of reasons that have the meaning of mental and physical trauma (physical fatigue, colds; troubles and worries associated with the funeral of a comrade) developed a convulsive seizure, after which the degree of mutation duplex remained ... These phenomena gradually disappeared over the course of about two months, and the deafness passed before the deafness.

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