Rotational vertebral artery occlusion secondary to completely extraosseous vertebral artery

Rendon, Rachel; Mannoia, Kristyn; Reiman, Steven; Hitchman, Louise; Shutze, William P.

doi:10.1016/j.jvscit.2018.09.006

Cited by 8 publications

(7 citation statements)

References 4 publications

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“…However, because of the collateral blood flow through the contralateral VA and the circle of Willis, VA occlusion does not lead to symptoms in most individual cases. Thus, cases of symptomatic rotational vertebral artery occlusion are very rare [ 34 ]. Investigation of the effect of the position of the head on flow rate in the vertebral arteries, as measured by Doppler ultrasound at rotations of 30 degrees up to 60 degrees to either side, revealed no changes in blood flow in healthy subjects, which means that common rotation of the cervical spine cannot elicit vertigo [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Vertigo in Patients with Degenerative Cervical Myelopathy

Kadaňka

Jura

Bednařík

2021

JCM

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(1) Background: Cervical vertigo (CV) represents a controversial entity, with a prevalence ranging from reported high frequency to negation of CV existence. (2) Objectives: To assess the prevalence and cause of vertigo in patients with a manifest form of severe cervical spondylosis–degenerative cervical myelopathy (DCM) with special focus on CV. (3) Methods: The study included 38 DCM patients. The presence and character of vertigo were explored with a dedicated questionnaire. The cervical torsion test was used to verify the role of neck proprioceptors, and ultrasound examinations of vertebral arteries to assess the role of arteriosclerotic stenotic changes as hypothetical mechanisms of CV. All patients with vertigo underwent a detailed diagnostic work-up to investigate the cause of vertigo. (4) Results: Symptoms of vertigo were described by 18 patients (47%). Causes of vertigo included: orthostatic dizziness in eight (22%), hypertension in five (14%), benign paroxysmal positional vertigo in four (11%) and psychogenic dizziness in one patient (3%). No patient responded positively to the cervical torsion test or showed significant stenosis of vertebral arteries. (5) Conclusions: Despite the high prevalence of vertigo in patients with DCM, the aetiology in all cases could be attributed to causes outside cervical spine and related nerve structures, thus confirming the assumption that CV is over-diagnosed.

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Section: Discussionmentioning

confidence: 99%

Vertigo in Patients with Degenerative Cervical Myelopathy

Kadaňka

Jura

Bednařík

2021

JCM

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“…This is the most common subtype of RVAI reported in the literature. 3,4,8,[16][17][18][19] In atlantoaxial RVAI, the V3 portion of the VA is compressed and can also be occluded with rotational head movement, which is presented in this illustrative case. This is most commonly caused by an ossified or thickened atlanto-occipital membrane, degenerative changes from cervical spondylosis, a dural fold in the foramen magnum, an accessory ossicle behind the atlanto-odontoid junction, C1-C2 facet hypertrophy, muscular and tendinous insertions, erosive rheumatoid arthritis, or dynamic instability, as in this case.…”

Section: Discussionmentioning

confidence: 90%

Atypical presentation of rotational vertebral artery insufficiency: illustrative case

Kantak

Priya

Bathla

et al. 2021

Journal of Neurosurgery: Case Lessons

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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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“…There have been only three previously reported cases in the literature regarding compression of the VA by the thyroid cartilage. [3][4][5] Rotational head movement accounted for compression in two cases, and neck flexion in one case. Our case is unique as our patient suffered VA compression due to mouth opening.…”

Section: Discussionmentioning

confidence: 99%

“…2 In only three prior reported cases, rotational compression of the VA has been precipitated by the thyroid cartilage during axial rotation of the head. [3][4][5] Here, we present a case of VA compression by the thyroid cartilage precipitated by mouth opening. This resulted in multiple infarcts to the cerebellum.…”

Section: Introductionmentioning

confidence: 96%

Compression of the Vertebral Artery by the Thyroid Cartilage Causing Vertebrobasilar Insufficiency

2023

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Background This retrospective case report describes a rare presentation of VBI in a young male patient. Aims Share a rare cause of VBI in a young patient. Materials & Methods The patient presented with recurrent episodes of dizziness and a history of several cerebellar infarcts. Imaging revealed the right vertebral artery was being mechanically compressed by the right superior cornu of the thyroid cartilage during mouth opening. Surgical resection of the right superior cornu of the thyroid cartilage was performed. Results Intraoperative angiography revealed a right vertebral artery without compression during mouth opening. Discussion Clinicians should consider the thyroid cartilage as a potential source of recurrent VBI due to mechanical compression of the VA. Conclusion Resection of the causative portion of the thyroid cartilage resolved the compression in this case, and should be employed in similar cases. Laryngoscope, 133:1214–1217, 2023

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Rotational vertebral artery occlusion secondary to completely extraosseous vertebral artery

Cited by 8 publications

References 4 publications

Vertigo in Patients with Degenerative Cervical Myelopathy

Vertigo in Patients with Degenerative Cervical Myelopathy

Atypical presentation of rotational vertebral artery insufficiency: illustrative case

Compression of the Vertebral Artery by the Thyroid Cartilage Causing Vertebrobasilar Insufficiency

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