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.

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.

Spontaneous atraumatic vertebral artery occlusion due to physiological cervical extension

2014 ◽  
Vol 20 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Mina G. Safain ◽  
Jordan Talan ◽  
Adel M. Malek ◽  
Steven W. Hwang
Keyword(s):  
Vertebral Artery ◽  
Head Movement ◽  
Head Rotation ◽  
Artery Occlusion ◽  
Vascular Compression ◽  
Vertebrobasilar Insufficiency ◽  
Cerebral Angiogram ◽  
Life Threatening ◽  
History Of ◽  
Hunter's Syndrome

Vertebral artery (VA) occlusion is a serious and potentially life-threatening occurrence. Bow hunter's syndrome, a mechanical occlusion of the VA due to physiological head rotation, has been well described in the medical literature. However, mechanical VA compression due to routine flexion or extension of the neck has not been previously reported. The authors present the unique case of a woman without any history of trauma who had multiple posterior fossa strokes and was found to have dynamic occlusion of her right VA visualized via cerebral angiogram upon extension of her neck. This occlusion was attributed to instability at the occipitocervical junction in a patient with a previously unknown congenital fusion of both the occiput to C-1 and C-2 to C-3. An occiput to C-3 fusion was performed to stabilize her cervical spine and minimize the dynamic vascular compression. A postoperative angiogram showed no evidence of restricted flow with flexion or extension of the neck. This case emphasizes the importance of considering symptoms of vertebrobasilar insufficiency as a result of physiological head movement. The authors also review the literature on VA compression resulting from physiological head movement as well as strategies for clinical diagnosis and treatment.

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

2014 ◽  
Vol 20 (6) ◽  
pp. 714-721 ◽  
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.

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.

Bow Hunter’s Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl

2020 ◽  
Vol 35 (11) ◽  
pp. 767-772 ◽  
Author(s):  
Meredith R. Golomb ◽  
Katrina A. Ducis ◽  
Mesha L. Martinez
Keyword(s):  
Vertebral Artery ◽  
English Language ◽  
Recurrent Stroke ◽  
Head Rotation ◽  
Hunter Syndrome ◽  
Artery Occlusion ◽  
Vascular Compression ◽  
Cervical Fusion ◽  
Male Predominance ◽  
Hunter's Syndrome

Background: Bow hunter's syndrome, or occlusion of the vertebral artery with head rotation leading to ischemia and sometimes stroke, is rarely described in children. The authors review the literature and present a new case. Methods: Both OVID dating back to 1946 and PubMed records were reviewed using the terms (“Bow hunter syndrome” OR “bow hunter’s”) OR “rotational vertebral artery occlusion” combined with “child,” and limited to English language. SCOPUS and the bibliographies of cases found in the search were used to identify additional articles. Results: Twelve articles were found describing 25 patients; there were 26 patients when combined with our case. Ages ranged from 1 to 18 years. Most (88.5%, 23/26) were male. Medical treatments included aspirin, clopidogrel, abciximab, enoxaparin, warfarin, and cervical collar. Stenting was tried in 2 cases but did not work long-term. Surgical treatments included decompression, cervical fusion, or a combination. We present a new case of a 12-year-old girl with recurrent stroke who had bilateral vascular compression only visible on provocative angiographic imaging with head turn. She was referred for cervical fusion, and abnormal ligamentous laxity was noted intraoperatively. Conclusions: Bow hunter's syndrome is a rare but important cause of stroke since many of the patients experience recurrent strokes before the diagnosis is made. Reasons for the male predominance are unclear. Provocative angiography plays a key role in diagnosis, and both medical treatment and neurosurgical intervention may prevent recurrence.

Rotational Vertebral Artery Occlusion: A Mechanism of Vertebrobasilar Insufficiency

Neurosurgery ◽  
1997 ◽  
Vol 41 (2) ◽  
pp. 427-433 ◽  
Author(s):  
Todd A. Kuether ◽  
Gary M. Nesbit ◽  
Wayne M. Clark ◽  
Stanley L. Barnwell
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Vertebrobasilar Insufficiency ◽  
Vertebral Artery Occlusion

Cryptic Recanalization of Chronic Vertebral Artery Occlusion by Head Rotation

2017 ◽  
Vol 26 (4) ◽  
pp. e60-e61 ◽  
Author(s):  
Kenji Yagi ◽  
Hiroshi Nakagawa ◽  
Hideo Mure ◽  
Shinya Okita ◽  
Shinji Nagahiro
Keyword(s):  
Vertebral Artery ◽  
Head Rotation ◽  
Artery Occlusion ◽  
Vertebral Artery Occlusion

scholarly journals Dimensions and Anatomical Variants of the Foramen Transversarium of Typical Cervical Vertebrae

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Santosh Kaur Sangari ◽  
Paul-Michel Dossous ◽  
Thomas Heineman ◽  
Estomih Phillip Mtui
Keyword(s):  
Vertebral Artery ◽  
Thrombus Formation ◽  
Cervical Vertebrae ◽  
Uncinate Process ◽  
Vertebrobasilar Insufficiency ◽  
Transverse Foramen ◽  
Medial Margin ◽  
Significant Difference ◽  
The Mean ◽  
The Right

The study was conducted on random sample of seventy-one dried, typical cervical vertebrae (C3–C6). The data on the age, sex, and built was not available. Using vernier calipers with 0.01 mm accuracy, the anteroposterior and transverse diameters of transverse foramina and their distance from the medial margin of the uncinate process were measured bilaterally. The mean diameter of the right/left transverse foramen varied from 2.54 mm to 7.79 mm (mean = 5.55 ± 0.87 mm) and from 2.65 mm to 7.35 mm (mean = 5.48 ± 0.77 mm), respectively. The transverse foramen was less than 3.5 mm in three vertebrae on the right and two on the left. The osteocytes observed in 21.3% of specimens and the narrow transverse foramen may place patients at risk for vertebrobasilar insufficiency or thrombus formation. The mean distance of the transverse foramen from the medial margin of uncinate process is an important landmark to avoid vertebral artery laceration and was 5.0 ± 0.87 mm (range: 3.5–7.9 mm) on the right and 5.0 ± 1.0 mm (range: 3.2–7.7 mm) on the left side. No statistically significant difference was observed between the right and left sides. The accessory transverse foramina seen in 24% of vertebrae suggest duplications or fenestrations in the vertebral artery.

Temporary vertebral artery occlusion after C3 fracture dislocation injury and spontaneous resolution following reduction and instrumented fusion: case report and literature review

2016 ◽  
Vol 9 (10) ◽  
pp. 1027-1030
Author(s):  
Kurt Yaeger ◽  
Justin Mascitelli ◽  
Christopher Kellner ◽  
Zachary Hickman ◽  
J Mocco ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Cerebral Angiography ◽  
Artery Occlusion ◽  
Fracture Dislocation ◽  
Vessel Occlusion ◽  
Traumatic Injuries ◽  
Vertebral Artery Occlusion ◽  
Typical Treatment ◽  
Cerebral Ischemic ◽  
The Right

Vertebral artery injuries as a result of blunt trauma can result in vertebrobasilar strokes. Typical treatment of such an injury includes early anticoagulation to prevent cerebral ischemic events due to vessel occlusion or embolism. We present a case of cervical fracture-dislocation injury and compression/occlusion of the right vertebral artery, which spontaneously resolved following surgical reduction and fusion. Postoperative cerebral angiography showed no evidence of vertebral artery stenosis, and systemic anticoagulation was discontinued. This case shows that vertebral artery occlusion can resolve spontaneously after fracture reduction, and cerebral angiography should play a role in assessing these complicated traumatic injuries.

scholarly journals Atypical presentation of rotational vertebral artery insufficiency: illustrative case

2021 ◽  
Vol 1 (9) ◽  
Author(s):  
Pranish A. Kantak ◽  
Sarv Priya ◽  
Girish Bathla ◽  
Mario Zanaty ◽  
Patrick W. Hitchon
Keyword(s):  
Vertebral Artery ◽  
Facet Joint ◽  
Head Rotation ◽  
Rotational Instability ◽  
Anatomical Location ◽  
Illustrative Case ◽  
Vertebrobasilar Insufficiency ◽  
Course Of Action ◽  
Heterogeneous Nature ◽  
The Right

BACKGROUNDRotational vertebral artery insufficiency (RVAI), also known as bow hunter’s syndrome, is an uncommon cause of vertebrobasilar insufficiency that leads to signs of posterior circulation ischemia during head rotation. RVAI can be subdivided on the basis of the anatomical location of vertebral artery compression into atlantoaxial RVAI (pathology at C1-C2) or subaxial RVAI (pathology below C2). Typically, RVAI is only seen with contralateral vertebral artery pathologies, such as atherosclerosis, hypoplasia, or morphological atypia.OBSERVATIONSThe authors present a unique case of atlantoaxial RVAI due to rotational instability, causing marked subluxation of the C1-C2 facet joints. This case is unique in both the mechanism of compression and the lack of contralateral vertebral artery pathology. The patient was successfully treated with posterior C1-C2 instrumentation and fusion.LESSONSWhen evaluating patients for RVAI, neurosurgeons should be aware of the variety of pathological causes, including rotational instability from facet joint subluxation. Due to the heterogeneous nature of the pathologies causing RVAI, care must be taken to decide if conservative management or surgical correction is the right course of action. Because of this heterogeneous nature, there is no set guideline for the treatment or management of RVAI.

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