scholarly journals Arteria vertebralis thrombosis egy 7 éves gyermekben

2021 ◽  
Vol 162 (47) ◽  
pp. 1902-1907
Keyword(s):  
Vertebral Artery ◽  
Ultrasound Examination ◽  
Time Of Flight ◽  
Circulatory System ◽  
Pediatric Intensive Care ◽  
Left Vertebral Artery ◽  
Time Interval ◽  
Arteria Vertebralis ◽  
History Of ◽  
The Right

Összefoglaló. Az agyi érrendszer elzáródásos panaszai elsősorban felnőttkorban jelentkeznek, nem ritkák azonban gyermekek esetében sem. A gyermekkori stroke gyakorisága 2,5/1 000 000 fő; ilyenkor általában az arteria carotis interna vagy az arteria cerebri media érintett. Az ischaemiás stroke-ok 25%-a a hátsó keringési rendszer területén keletkezik. Az arteria vertebralis extracranialis szakaszának stenosisa 18%-ban a jobb oldalon, 22,3%-ban a bal oldalon észlelhető. Esetünkben egy 7 éves kisfiú kórtörténetét mutatjuk be, aki facialis paresis, súlyosbodó ataxia és somnolentia tüneteivel került egy megyei kórház gyermek intenzív osztályára. A készült kontrasztos koponya angiográfiás MR-vizsgálaton akut ischaemiás elváltozások voltak láthatók, valamint sejteni lehetett, hogy a bal oldali arteria vertebralis gracilisabb; a hypoplasia azonban csak a beteg egyetemi centrumba kerülése után, az ott elvégzett, a nyaki erekre is kiterjedő TOF - (time of flight) angiográfia és nyaki ultrahang készítését követően bizonyosodott be. A beállított gyógyszeres kezelések hatására az ischaemiát okozó artériás thrombus feloldódott, majd megkezdődött a rehabilitáció folyamata, melynek során a beteg állapota nagymértékben javult. A gyermek kórházba kerülése előtt hónapokkal észlelt, magatartás- és figyelembeli zavarainak romlása felveti a már korábban bekövetkező átmeneti ischaemiás periódusok lehetőségét is. A hátsó keringési rendszert érintő stroke-ok etiológiája változó, többször kerültek már leírásra különböző háttérrel. Esetünkben a fejlődési rendellenesség – ’bow hunter’ szindróma tűnik a legvalószínűbbnek. A készült dinamikus nyaki ultrahangvizsgálat is erre utaló eredményt adott. Időintervallumon belül szóba jöhet az arteria vertebralis thrombosis kezelése endovascularis módszerek segítségével is. Ennek kivitelezhetősége érdekében azonban fontos a mielőbbi pontos diagnózis felállítása a megfelelő képalkotó vizsgálatok segítségével és a betegnek a kezelésére felkészült centrumba juttatása. Orv Hetil. 2021; 162(47): 1902–1907. Summary. Cerebrovascular obstruction primarily affects adults, but it is not uncommon in children either. The incidence of childhood stroke is 2.5/1 000 000 population, usually affecting the internal carotid artery or the middle cerebral artery. The posterior circulatory system is involved in 25% of ischemic strokes. Stenosis of the extracranial section of the vertebral artery is demonstrated in 18% on the right side and 22.3% on the left side. We present the case history of a 7-year-old boy who was admitted to the pediatric intensive care unit of a county hospital with symptoms of facial palsy, progrediating ataxia and somnolence. Contrast-enhanced angiographic MR images of the skull revealed acute ischemic lesions and suggested stenosis of the left vertebral artery, then it was confirmed by TOF (time of flight) angiography of vessels of the neck and cervical ultrasound examination. The arterial thrombus causing ischaemia was eliminated by drug treatment and the rehabilitation process could be started. The patient’s condition improved considerably following that. Deterioration in behavioral and attentional problems of the patient, which had been realised months prior to hospitalisation, raises the possibility of earlier ischemic periods. The etiology of strokes affecting the posterior circulatory system has been described with different backgrounds. In the presented case, a developmental disorder – bow hunter’s syndrome seems to be the most likely one. The result of dynamic cervical ultrasound examination also supported this theory. Treatment of vertebral artery thrombosis with endovascular methods may also be considered within a time interval. However, to make it feasible, it is important to establish an accurate diagnosis as soon as possible by appropriate imaging studies, and to transfer the patient to a specialised center. Orv Hetil. 2021; 162(47): 1902–1907.

scholarly journals Vertebral artery dissecting aneurysm treated by internal trapping via the contralateral vertebral artery: A case report

2015 ◽  
Vol 21 (5) ◽  
pp. 576-579 ◽  
Author(s):  
Atsuhiro Kojima
Keyword(s):  
Vertebral Artery ◽  
Sudden Onset ◽  
Dissecting Aneurysm ◽  
Left Vertebral Artery ◽  
Distal Side ◽  
Consciousness Disturbance ◽  
History Of ◽  
The Right ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Guiding Catheter

A 42-year-old man with a history of sudden onset of severe headache followed by consciousness disturbance was brought to our hospital. Radiological examinations revealed subarachnoid hemorrhage, associated with rupture of a left vertebral artery dissecting aneurysm. Initially, internal trapping was attempted via the ipsilateral vertebral artery. However, the microcatheter could not be navigated through the true lumen to the distal side of the vertebral artery. Subsequently, therefore, the guiding catheter was placed in the right vertebral artery, and the microcatheter was retrogradely navigated successfully through the lesion to the proximal side of the left vertebral artery. Finally, the lesion was completely embolized with electrodetachable coils without complications. However, the patient died after the operation because of deterioration of the general condition. The postmortem examination revealed how an intimal flap had interfered with the antegrade navigation of the microcatheter in the lesion. The present case showed that endovascular treatment for a vertebral artery dissecting aneurysm via the contralateral vertebral artery may be a useful option in cases where antegrade navigation of the microcatheter via the ipsilateral vertebral artery is found to be difficult.

Subarachnoid hemorrhage in a case of segmental arterial mediolysis with coexisting intracranial and intraabdominal aneurysms

2012 ◽  
Vol 116 (5) ◽  
pp. 948-951 ◽  
Author(s):  
Ryosuke Matsuda ◽  
Yasuo Hironaka ◽  
Yasuhiro Takeshima ◽  
Young-Su Park ◽  
Hiroyuki Nakase
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Distal Portion ◽  
Dissecting Aneurysm ◽  
Arterial System ◽  
Left Vertebral Artery ◽  
Retroperitoneal Hemorrhage ◽  
Segmental Arterial Mediolysis ◽  
History Of ◽  
The Right ◽  
Distal Anterior Cerebral Artery

The authors report the rare case of a 58-year-old man with segmental arterial mediolysis (SAM) with associated intracranial and intraabdominal aneurysms, who suffered subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm. This disease primarily involves the intraabdominal arterial system, resulting in intraabdominal and retroperitoneal hemorrhage in most cases. The patient presented with severe headache and vomiting. The CT scans of the head revealed SAH. Cerebral angiography revealed 3 aneurysms: 1 in the right distal anterior cerebral artery (ACA), 1 in the distal portion of the A1 segment of the right ACA, and 1 in the left vertebral artery. The patient had a history of multiple intraabdominal aneurysms involving the splenic, gastroepiploic, gastroduodenal, and bilateral renal arteries. He underwent a right frontotemporal craniotomy and fibrin coating of the dissecting aneurysm in the distal portion of the A1 segment of the right ACA, which was the cause of the hemorrhage. Follow-up revealed no significant changes in the residual intracranial and intraabdominal aneurysms. An SAH due to SAM with associated multiple intraabdominal aneurysms is extremely rare. The authors describe their particular case and review the literature pertaining to SAM with associated intracranial and intraabdominal aneurysms.

scholarly journals Progressive cervicocranial arteriopathy with dilatations and stenoses: case report

2004 ◽  
Vol 62 (3b) ◽  
pp. 899-902 ◽  
Author(s):  
Adriana Bastos Conforto ◽  
Paulo Puglia Jr ◽  
Fábio Iuji Yamamoto ◽  
Milberto Scaff
Keyword(s):  
Vertebral Artery ◽  
Carotid Arteries ◽  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
Left Vertebral Artery ◽  
Fusiform Aneurysm ◽  
Pathogenetic Mechanism ◽  
Pontine Infarction ◽  
The Right ◽  
Internal Carotid Arteries

We report the case of a 36 year-old woman who presented occlusion of a basilar artery fusiform aneurysm (FA) associated with pontine infarction, and two episodes of subarachnoid hemorrhage possibly due to arterial dissection. She also had asymptomatic FAs in the right middle cerebral and left internal carotid arteries. Over 5 years, lesions suggestive of fibromuscular dysplasia in the right vertebral artery and occlusion of the left vertebral artery were observed. This combination of lesions emphasizes the possibility of a common pathogenetic mechanism causing different degrees of media disruption in cervicocranial arteries.

scholarly journals Cardiac tamponade secondary to hemorrhagic pericardial effiision in five dogs

2017 ◽  
Vol 56 (1) ◽  
pp. 9
Author(s):  
C. G. HATZIGIANNAKIS (Χ.Γ. ΧΑΤΖΗΓΙΑΝΝΑΚΗΣ) ◽  
M. E. MYLONAKIS (Μ. Ε. ΜΥΛΩΝΑΚΗΣ) ◽  
M. N. SARIDOMICHELAKIS (Μ.Ν. ΣΑΡΙΔΟΜΙΧΕΛΑΚΗΣ) ◽  
M. PATSIKAS (Μ. ΠΑΤΣΙΚΑΣ) ◽  
D. PSALLA (Δ. ΨΑΛΛΑ) ◽  
...  
Keyword(s):  
Ultrasound Examination ◽  
Histopathological Examination ◽  
Clinical Findings ◽  
Pericardial Fluid ◽  
Exercise Intolerance ◽  
Right Atrial ◽  
Atrial Wall ◽  
History Of ◽  
Cardiac Silhouette ◽  
The Right

A 7-year old female collie (case 1), a 3-year old male Caucasian-cross (case 2) and three male German shepherds with an age of 11 (case 3), 8.5 (case 4) and 10 (case 5) years, respectively, were admitted with a history of decreased appetite, depression, exercise intolerance, dyspnea and progressive abdominal enlargement, for the last 10 to 60 days. Poor body condition (5/5), muffled heart sounds (5/5), weak femoral pulse (5/5), ascites (5/5), inspiratory or inspiratory-expiratory dyspnea (5/5), pulsus paradoxus (2/5) and jugular vein distension (2/5) were the prominent clinical findings, while mature neutrophilic leukocytosis (3/5), lymphopenia (3/5), eosinopenia (3/5), hypoproteinemia (5/5) and increased urea nitrogen (3/5) were the most prevalent clinicopathologic abnormalities. Apart from a space-occupying lesion onto the right atrial wall of one dog (case 4), radiographic and ultrasound examination showed a globe-shaped cardiac silhouette (5/5), pericardial effusion (5/5), ascites (5/5) and pleural effusion (4/5). A large amount of non-clotting hemorrhagic effusion was drained during pericardiocentesis, resulting in rapid clinical recovery. Physical, chemical and cytological evaluation of the pericardial fluid was non-contributory in the differentiation between neoplastic and non-neoplastic causes of these effusions. Case 3 died 25 days post-pericardiocentesis; right atrium hemangiosarcoma and pulmonary metastases were documented on post mortem histopathological examination. Another dog (case 5) died of unknown causes one month after pericardiocentensis. On the contrary, dogs 1, 2 and 4 were still clinically healthy for a followup period of 16, 2 and 8 months, respectively.

scholarly journals Direct puncture of the V3 segment of the vertebral artery in acute basilar artery stroke: an alternative approach in desperate circumstances

2019 ◽  
Vol 12 (8) ◽  
pp. e231335 ◽  
Author(s):  
Sean Thomas O’Reilly ◽  
Ian Rennie ◽  
Jim McIlmoyle ◽  
Graham Smyth
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Left Vertebral Artery ◽  
Basilar Artery Thrombosis ◽  
Direct Puncture ◽  
Alternative Approach ◽  
Cerebellar Artery ◽  
First Pass ◽  
The Right

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

scholarly journals An Unusual Suspect for a Traumatic Arteriovenous Fistula in the Left Vertebral Artery

2020 ◽  
Vol 44 (1) ◽  
pp. 28-31
Author(s):  
Cassey Y. Noh
Keyword(s):  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Genetic Disorders ◽  
Invasive Procedure ◽  
Left Vertebral Artery ◽  
Medical Procedure ◽  
Doppler Waveform ◽  
Spectral Doppler ◽  
Vascular Laboratory ◽  
History Of

This case study discusses an unusual vertebral arteriovenous fistula of a patient with no history of an invasive medical procedure or underlying genetic disorders. The patient is a 54-year-old female with a history of tinnitus for 6 months behind the left ear prior to coming to the vascular laboratory. There was a connection between the left vertebral artery and the vertebral vein, which showed a mosaic pattern with a high velocity. The spectral Doppler waveform in the vertebral vein post the unintended anastomosis showed an arterialized venous Doppler waveform, confirming that the area of the interest was indeed an arteriovenous fistula. The image of the screening computed tomography performed on the same day did not show this connection or dilated venous system, possibly because of the small size of the fistula. A published literature suggests hyperextension as a possible suspect. There are a few test modalities that can identify an arteriovenous fistula, but ultrasound maybe the most desirable due to the fact that it does not involve an invasive procedure or a contrast dye. It is very important for a sonographer to learn the advanced information such as how to identify a true arteriovenous fistula with the analysis of Doppler waveform in the vein post the anastomosis. In doing so, it will increase the sonographer’s knowledge as well as promoting the field of ultrasound overall.

Vascular decompression of a vertebral artery loop producing cervical radiculopathy

1998 ◽  
Vol 89 (3) ◽  
pp. 485-488 ◽  
Author(s):  
Paul W. Detwiler ◽  
Randall W. Porter ◽  
Timothy R. Harrington ◽  
Volker K. H. Sonntag ◽  
Robert F. Spetzler
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Vascular Structure ◽  
Loop Formation ◽  
Content Type ◽  
History Of ◽  
Radicular Symptoms ◽  
The Right ◽  
Vascular Decompression

✓ Vertebral artery tortuosity and loop formation are rare causes of cervical radiculopathy. The authors present the case of a 70-year-old man with 9 years of progressive right-sided cervical and scapular pain but no history of trauma. Computerized tomography myelography and magnetic resonance imaging revealed an ovoid mass in the right C3–4 intervertebral foramen. The patient underwent a right C-3 and C-4 hemilaminectomy and a complete C3–4 facetectomy. A pulsatile vascular structure was found compressing the right C-4 nerve root. The bone overlying the vascular structure was removed, producing decompression of the nerve root. Immediate postoperative angiography showed that this lesion was a focal vertebral artery loop. The patient's symptoms resolved after surgery, supporting the use of vascular decompression of a cervical nerve root compressed by a vertebral artery loop for the relief of radicular symptoms.

Bow Hunter's Syndrome: Complete Microsurgical Decompression of Vertebral Artery by Far Lateral Retrocondylar Approach: 3-Dimensional Operative Video

2019 ◽  
Author(s):  
Qazi Zeeshan ◽  
Juan P Carrasco Hernandez ◽  
Laligam N Sekhar
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Dynamic Compression ◽  
Skin Incision ◽  
Left Vertebral Artery ◽  
Occipital Condyle ◽  
Cerebral Angiogram ◽  
Microsurgical Decompression ◽  
C2 Nerve Root ◽  
The Right

Abstract This 50-yr-old man had a 15-yr history of presyncopal episodes that were precipitated by turning his head to the right, and had worsened recently. Cerebral angiogram demonstrated complete cessation of anterograde flow in left vertebral artery (VA) at the level of the C1 sulcus arteriosus while turning head to right, indicating dynamic compression at the C1 level.  Patient underwent left extreme lateral retrocondylar approach, partial C1 laminectomy and opening of the C1 foramen with complete microsurgical decompression of the VA. After skin incision, meticulous muscle dissection was performed and superior and inferior oblique muscles were disconnected from the tubercle of C1. The VA was exposed, and three areas of constriction were visible, first at the atlanto-occipital membrane laterally; second, located more medially as the artery curved around the occipital condyle to enter the posterior fossa; and third, located anterior to C2 nerve root. The artery was dissected from all the surrounding tissues, preserving the C2 nerve root, and the Cl foramen was opened completely. The Cl lamina was also partially resected and grooved to allow free placement of the VA. The VA was also decompressed near the C2 foramen. Postoperative computed tomography angiogram of the head and neck showed complete decompression of VA. The patient had no episodes of presyncope or dizziness while turning head to right and his mRs was 0 at 8 mo follow up.  This 3D video shows the technical nuances of decompression of V3 segment of VA in bow hunters's syndrome.  Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

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