Rotational Vertebral Artery Occlusion: A Mechanism of Vertebrobasilar Insufficiency

✓ A case is described in which vertebral artery occlusion, caused by a fibrous band, occurred whenever the patient turned his head to the right side, resulting in vertigo and syncope whenever the head was turned to the right. Release of a fibrous band crossing the vertebral artery 2 cm from its origin relieved the patient's vertebral artery constriction and symptoms.

Download Full-text

Vertebrobasilar insufficiency in rheumatoid atlanto-axial subluxation: a case report with angiographic demonstration of left vertebral artery occlusion

Journal of Neurology ◽

10.1007/bf00314317 ◽

1988 ◽

Vol 235 (3) ◽

pp. 189-190 ◽

Cited By ~ 15

Author(s):

S. J. L. Howell ◽

A. J. Molyneux

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Artery Occlusion ◽

Left Vertebral Artery ◽

Vertebrobasilar Insufficiency ◽

Vertebral Artery Occlusion ◽

Angiographic Demonstration

Download Full-text

Rotational vertebral artery occlusion secondary to adjacent-level degeneration following anterior cervical discectomy and fusion

Journal of Neurosurgery Spine ◽

10.3171/2014.3.spine13452 ◽

2014 ◽

Vol 20 (6) ◽

pp. 714-721 ◽

Cited By ~ 11

Author(s):

Colin C. Buchanan ◽

Nancy McLaughlin ◽

Daniel C. Lu ◽

Neil A. Martin

Keyword(s):

Vertebral Artery ◽

Head Rotation ◽

Artery Occlusion ◽

Adjacent Segment Degeneration ◽

Anterior Cervical Discectomy ◽

Herniated Disc ◽

Adjacent Segment ◽

Vertebrobasilar Insufficiency ◽

Cervical Discectomy ◽

Vertebral Artery Occlusion

Rotational vertebral artery occlusion (RVAO), or bow hunter's syndrome, most often occurs at the C1–2 level on physiological head rotation. It presents with symptoms of vertebrobasilar insufficiency (VBI). Several previously published studies have reported on subaxial sites of vertebral artery (VA) compression by head rotation. The authors report a case of subaxial spine RVAO due to adjacent-segment degeneration. A 52-year-old man presented with dizziness when rotating his head to the left. Twenty years earlier, he had undergone a C4–5 anterior cervical discectomy and fusion (ACDF) for a herniated disc. Imaging studies including a dynamic CT angiography and dynamic catheter angiography revealed occlusion of the left VA at the C3–4 level when the patient turned his head to the left, in the setting of an aberrant vertebrobasilar system. Successful treatment was achieved by surgical decompression of the left VA and C3–4 ACDF. Expedited diagnosis and treatment are dependent on the recognition of this unusual manifestation of RVAO, especially when patients present with nonspecific symptoms of VBI.

Download Full-text

Rotational vertebral artery occlusion: Case report and review of literature

Journal of Clinical Case reports and reviews ◽

10.36879/jccrr.18.000115 ◽

2018 ◽

pp. 1-3

Keyword(s):

Vertebral Artery ◽

Head Rotation ◽

Transcranial Doppler Ultrasound ◽

Artery Occlusion ◽

Vascular Lesion ◽

Vascular Compression ◽

Vertebrobasilar Insufficiency ◽

Transverse Foramen ◽

Vertebral Artery Occlusion ◽

The Right

Rotational vertebral artery occlusion (RVAO) classically involves transient, position-dependent vertebrobasilar insufficiency (VBI) that occurs when an extra-vascular lesion (e.g. osteophyte or fibromuscular band) compresses a dominant vertebral artery with turning of the head to one side. Our patient presented with VBI associated vertigo, dizziness, and lightheadedness that occurred when her head was turned to the right. RVAO was initially suggested by transcranial Doppler ultrasound (TCD) changes that were not supported by initial catheter angiography. After her symptoms worsened over a course of two years, the diagnosis was confirmed with repeat angiography with head rotation. Further imaging with computed tomography and magnetic resonance demonstrated spondylosis at the C5-C6 vertebrae and an osteophyte near the C5 transverse foramen, which caused position-dependent extra-vascular compression. She was treated with surgical decompression and anterior discectomy and fusion at C5-C6. The unique anatomical pathology of this case combined with the diagnostic discrepancy between early TCD and angiography make it an interesting contribution to the otherwise limited body of literature on RVAO.

Download Full-text

OCCIPITAL ARTERY-TO-POSTERIOR INFERIOR CEREBELLAR ARTERY BYPASS FOR TREATMENT OF BILATERAL VERTEBRAL ARTERY OCCLUSION: THE ROLE OF QUANTITATIVE MAGNETIC RESONANCE ANGIOGRAPHY NONINVASIVE OPTIMAL VESSEL ANALYSIS

Neurosurgery ◽

10.1227/01.neu.0000339351.65061.d6 ◽

2009 ◽

Vol 64 (4) ◽

pp. E779-E781 ◽

Cited By ~ 9

Author(s):

Robert M. Starke ◽

Mark Chwajol ◽

Daniel Lefton ◽

Chandranath Sen ◽

Alejandro Berenstein ◽

...

Keyword(s):

Magnetic Resonance ◽

Vertebral Artery ◽

Artery Bypass ◽

Posterior Inferior Cerebellar Artery ◽

Artery Occlusion ◽

Occipital Artery ◽

Vertebrobasilar Insufficiency ◽

Vertebral Arteries ◽

Vertebral Artery Occlusion ◽

Cerebellar Artery

Abstract OBJECTIVE Patients with partial or complete bilateral vertebral artery occlusion often present with signs and symptoms of transient ischemic attacks or infarction. Advances in phase contrast magnetic resonance imaging have led to noninvasive assessment of volumetric blood flow rates and direction that help in the workup and management of these patients. CLINICAL PRESENTATION We present the case of a patient with symptoms of vertebrobasilar insufficiency without previous transient ischemic attacks or stroke. Quantitative magnetic resonance angiography (QMRA) demonstrated bilateral vertebral artery occlusion with reversal of flow in the basilar and vertebral arteries to the level of the posterior inferior cerebellar arteries bilaterally. A prominent right posterior communicating artery filled the basilar artery and proximal vertebral arteries. INTERVENTION The presence of reversal and diminished flow in the basilar and vertebral arteries suggested that occipital artery-to-posterior inferior cerebellar artery bypass would improve posterior circulation, relieve symptoms, and reduce the risk of infarction. Postoperative QMRA and angiography confirmed revascularization, and QMRA confirmed correction of blood flow direction. CONCLUSION This case illustrates the potential of QMRA as part of a comprehensive cerebrovascular assessment, operative planning, and follow-up of patients with vertebrobasilar insufficiency.

Download Full-text