Rotational obstruction of nondominant vertebral artery and ischemia

1996 ◽  
Vol 85 (3) ◽  
pp. 507-509 ◽  
Author(s):  
Tetsuya Morimoto ◽  
Takanobu Kaido ◽  
Yoshitomo Uchiyama ◽  
Hidemori Tokunaga ◽  
Toshisuke Sakaki ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Three Dimensional ◽  
Artery Occlusion ◽  
Left Vertebral Artery ◽  
Posterior Fixation ◽  
Vertebrobasilar Insufficiency ◽  
Atlantoaxial Joint ◽  
Head Turning ◽  
Content Type ◽  
The Right

✓ A 70-year-old man presented with repeated vertebrobasilar insufficiency for 3 years. Four-vessel angiography revealed complete occlusion of the nondominant left vertebral artery on head turning to the right. Three-dimensional computerized tomography angiography demonstrated atlantoaxial joint dislocation when the head was turned to the right, in accordance with simultaneous occlusion of the left vertebral artery caused by stretching of the artery at C1–2. After posterior fixation of C1–2 by a Halifax interlaminar fixation system, the patient had no further episodes. Hemodynamic function associated with nondominant vertebral artery occlusion contributed to the symptoms in this case.

Anterolateral decompression of the atlantoaxial vertebral artery for symptomatic positional occlusion of the vertebral artery

1995 ◽  
Vol 83 (4) ◽  
pp. 737-740 ◽  
Author(s):  
Mark W. Fox ◽  
David G. Piepgras ◽  
John D. Bartleson
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Artery Occlusion ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Mechanical Compression ◽  
Head Turning ◽  
Content Type ◽  
The Right ◽  
Bow Hunter’S Stroke

✓ A case of repeated vertebrobasilar ischemic attacks related to head rotation (bow hunter's stroke) is reported. With head rotation of 45° or more to the right, the patient would become lightheaded and feel as if she were going to lose consciousness. Angiography performed when head rotation was to the right revealed mechanical compression of the left vertebral artery at the foramen transversarium of the axis and an occluded right vertebral artery. Untethering of the vertebral artery as it passed through the foramen transversarium of the atlas in this case completely relieved the patient's symptoms. The authors conclude that contralateral vertebral artery occlusion predisposed this patient to symptomatic vertebrobasilar insufficiency secondary to ipsilateral vertebral artery mechanical stenosis induced by head turning.

Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band

1982 ◽  
Vol 56 (4) ◽  
pp. 581-583 ◽  
Author(s):  
Timothy Mapstone ◽  
Robert F. Spetzler
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Vertebrobasilar Insufficiency ◽  
Fibrous Band ◽  
Content Type ◽  
Vertebral Artery Occlusion ◽  
The Right ◽  
Band Crossing ◽  
Fine Print

✓ 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.

Rotational vertebral artery occlusion from occipital bone anomaly: a rare cause of embolic stroke

2002 ◽  
Vol 97 (6) ◽  
pp. 1456-1459 ◽  
Author(s):  
Teiji Tominaga ◽  
Toshiyuki Takahashi ◽  
Hiroaki Shimizu ◽  
Takashi Yoshimoto
Keyword(s):  
Vertebral Artery ◽  
Three Dimensional ◽  
Craniovertebral Junction ◽  
Artery Occlusion ◽  
Occipital Bone ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ Vertebral artery (VA) occlusion by rotation of the head is uncommon, but can result from mechanical compression of the artery, trauma, or atlantoaxial instability. Occipital bone anomalies rarely cause rotational VA occlusion, and patients with nontraumatic intermittent occlusion of the VA usually present with compromised vertebrobasilar flow. A 34-year-old man suffered three embolic strokes in the vertebrobasilar system within 2 months. Magnetic resonance imaging demonstrated multiple infarcts in the vertebrobasilar territory. Angiography performed immediately after the third attack displayed an embolus in the right posterior cerebral artery. Radiographic and three-dimensional computerized tomography bone images exhibited an anomalous osseous process of the occipital bone projecting to the posterior arch of the atlas. Dynamic angiography indicated complete occlusion of the left VA between the osseous process and the posterior arch while the patient's head was turned to the right. Surgical decompression of the VA resulted in complete resolution of rotational occlusion of the artery. An occipital bone anomaly can cause rotational VA occlusion at the craniovertebral junction in patients who present with repeated embolic strokes resulting from injury to the arterial wall.

scholarly journals A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Katleen Devue ◽  
Annemie Van Ingelgem ◽  
Katrien De Keukeleire ◽  
Marc De Leeuw
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Minor Trauma ◽  
Systemic Thrombolysis ◽  
The Right

This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

Microvascular anatomy of foramen caecum medullae oblongatae

1991 ◽  
Vol 75 (2) ◽  
pp. 299-304 ◽  
Author(s):  
Asim Mahmood ◽  
Manuel Dujovny ◽  
Maximo Torche ◽  
Ljubisa Dragovic ◽  
James I. Ausman
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Foramen Magnum ◽  
Left Vertebral Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Outer Diameter ◽  
Vertebrobasilar Insufficiency ◽  
High Concentration ◽  
Content Type ◽  
Fine Print

✓ The foramen caecum (FC) is a triangular-shaped fossa situated in the midline on the base of the brain stem, at the pontomedullary junction. Although this area is known to have a very high concentration of brainstem perforating vessels, its microvascular anatomy has not been studied in detail. The purpose of this study was to detail the microvasculature of this territory. Twenty unfixed brains were injected with silicone rubber solution and dissected under a microscope equipped with a camera. The origin, course, outer diameter, and branching pattern of the perforators were examined. The total number of perforators found in the 20 brains was 287, with an average (± standard deviation) of 14.35 ± 1.24 perforators per brain (range seven to 28). Their origin was as follows: right vertebral artery in 52 perforators (18.11%); left vertebral artery in 35 (12.19%); basilar artery below the anterior inferior cerebellar artery (AICA) in 139 (48.43%); basilar artery above the AICA in 46 (16.02%); AICA in 10 (3.48%); and anterior spinal artery in five (1.74%). Most of the perforators arose as sub-branches of larger trunks; their average outer diameter was 0.16 ± 0.006 mm while that of trunks was 0.35 ± 0.02 mm. These anatomical data are important for those wishing 1) to study the pathophysiology of vascular insults to this area caused by atheromas, thrombi, and emboli; 2) to plan vertebrobasilar aneurysm surgery; 3) to plan surgery for vertebrobasilar insufficiency; and 4) to study foramen magnum neoplasms.

Posttraumatic bilateral vertebral artery occlusion

1981 ◽  
Vol 54 (6) ◽  
pp. 814-817 ◽  
Author(s):  
Eric G. Six ◽  
W. Lynn Stringer ◽  
A. Ron Cowley ◽  
Courtland H. Davis
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Posterior Fixation ◽  
Kirschner Wires ◽  
Content Type ◽  
Vertebral Arteries ◽  
Vertebral Artery Occlusion ◽  
Neurologically Normal ◽  
Collateral Vessels ◽  
Fine Print

✓ A case of bilateral vertebral artery occlusion following trauma in a 25-year-old woman is presented. The patient had minimal subluxation of C-2 on C-3 without neurological deficit. Her neck was immobilized for 16 days, and then a posterior fixation of C-1 through C-4 was performed with Kirschner wires and methyl methacrylate. Occlusion of the vertebral arteries has persisted, but collateral vessels are adequate and the patient has remained neurologically normal.

Rotational occlusion of the vertebral artery caused by transverse process hyperrotation and unilateral apophyseal joint subluxation

1997 ◽  
Vol 86 (6) ◽  
pp. 1031-1035 ◽  
Author(s):  
Tetsuro Kawaguchi ◽  
Shigekiyo Fujita ◽  
Kohkichi Hosoda ◽  
Yuji Shibata ◽  
Masaki Iwakura ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Three Dimensional ◽  
Head Rotation ◽  
Transverse Process ◽  
Content Type ◽  
X Ray ◽  
Articular Process ◽  
Inner Surface ◽  
The Right ◽  
Anterior Root

✓ The authors describe transverse process hyperrotation and unilateral apophyseal joint subluxation as a novel mechanism of rotational vertebral artery (VA) occlusion. The patient, a 56-year-old man, complained of episodic bilateral blindness when rotating his head more than 90° to the right. Plain cervical x-ray films showed spondylotic osteophytes of the right C4–5 uncovertebral portion. Dynamic angiography revealed right VA occlusion at C4–5 and left VA occlusion at C1–2 with head rotation to the right. It was demonstrated on three-dimensional images constructed from computerized tomography scans that C-4 transverse process hyperrotation compressed the right VA against the apex of the C-5 subluxating superior articular process via the inner surface of the transverse process anterior root (processus costarius) rather than the osteophytes. It is also proposed that the true site of occlusion is different from that observed in angiographic studies.

Rotational vertebrobasilar insufficiency as a component of thoracic outlet syndrome resulting in transient blindness

1994 ◽  
Vol 81 (4) ◽  
pp. 617-619 ◽  
Author(s):  
James J. Sell ◽  
Jesse R. Rael ◽  
William W. Orrison
Keyword(s):  
Vertebral Artery ◽  
Thoracic Outlet Syndrome ◽  
Head Rotation ◽  
Cortical Blindness ◽  
Left Vertebral Artery ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Aged Woman ◽  
Extrinsic Compression ◽  
Vertebral Artery Compression

✓ Cases of unilateral vertebral artery compression associated with thoracic outlet syndrome infrequently result in symptoms and, of those that do, most involve the brain stem. Reports of transient blindness resulting from this condition are even more rare. The authors describe the case of a middle-aged woman who presented with transient blindness when she turned her head excessively to the left. She also exhibited other less severe brainstem symptoms. Arteriography demonstrated occlusion of the left vertebral artery only when her head was rotated to the left. Surgical exploration revealed entrapment of the left vertebral artery by a tight anterior scalene muscle, release of which resulted in complete resolution of her symptoms. Both neurosurgeons and radiologists need to be aware that extrinsic compression of the vertebral artery precipitated by head rotation may sometimes result in transient cortical blindness.

Rotational vertebral artery occlusion: Case report and review of literature

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.

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