Sonography of Vertebral Arteries in De Kleyn's Position in Subjects and in Patients with Vertebrobasilar Transient Ischemic Attacks

Abstract

Two groups of subjects, matched for age, were studied. The first group consisted of 190 healthy subjects, the second, of 60 patients with vertebrobasilar transient ischemic attacks (TIAs), 22 of whom underwent angiography. After it was ascertained that the findings from continuous-wave (cw) Doppler of carotid and vertebral arteries, performed in the standard position, were normal, the examination was then done in De Kleyn's position, the velocity signal being detected at the mastoidal slopes. The abnormal findings were classified into two groups: "loss of diastolic velocity signal" and "absence of velocity signal." In the control group, changes of flow were detected in 6.31%, whereas in the group of patients abnormal Doppler parameters were detected in 33.33%. None of the patients who were submitted to angiography showed abnormal hemodynamic findings. The authors suggest that the detection of the velocity signal of the vertebral arteries in De Kleyn's position could be of help in revealing conditions that could cause, in time, signs and/or symptoms of vertebrobasilar insufficiency in subjects with possible asymptomatic anomalies of the circle of Willis.

Cervical arterial dissection: An overview and implications for manipulative therapy practice

“…the vertebral artery contralateral to the direction of cervical rotation, but others report no change (Arnetoli et al 1989, Haynes et al 2002, Mitchell, 2003, Thiel et al 1994, Weingart and Bischoff, 1992, Zaina et al, 2003. There is natural variability in blood flow between individuals which does not support theories of biomechanical strain on the artery or risk of arterial dissection.…”

Color duplex sonographic findings in human vertebral arteries during cervical rotation

“…In this way, Doppler sonography may indirectly assess the mechanical stresses to the arterial wall. This could be useful in premanipulative screening of vertebral arteries, especially considering the literature 12,13 indicating that positional stenosis of vertebral arteries is an independent risk factor for vertebrobasilar stroke.…”

“…7 Although chiropractors 8 and physiotherapists 9 commonly indirectly assess vertebral artery blood flow using neck rotation, neck extension, or both to provoke symptoms of vertebrobasilar ischemia, there is evidence that these tests are not valid. 10,11 The results of 2 studies, 1 by Arnetoli et al, 12 who used a Doppler velocimeter, and the other by Weintraub and Khoury, 13 who employed magnetic resonance angiography (MRA), showed that the presence of vertebral artery stenosis during contralateral neck rotation constituted an independent risk factor for stroke. Arnetoli et al 12 recommended that Doppler velocimetry of vertebral arteries during neck rotation be used in premanipulative screening.…”

“…10,11 The results of 2 studies, 1 by Arnetoli et al, 12 who used a Doppler velocimeter, and the other by Weintraub and Khoury, 13 who employed magnetic resonance angiography (MRA), showed that the presence of vertebral artery stenosis during contralateral neck rotation constituted an independent risk factor for stroke. Arnetoli et al 12 recommended that Doppler velocimetry of vertebral arteries during neck rotation be used in premanipulative screening. A recent study by 1 author (M. J. H.) 4 compared the results of Doppler velocimetry with those of color duplex sonography.…”

Posterior Ponticles and Rotational Stenosis of Vertebral Arteries. A Pilot Study Using Doppler Ultrasound Velocimetry and Magnetic Resonance Angiography

“…It seems that no studies have been made on the possible effect posterior ponticles have on the frequency of rotational stenosis of vertebral arteries, which 2 studies have indicated is an independent risk factor for stroke in the vertebrobasilar territory. 6,7 The aim of this pilot study was to make a preliminary test of the hypothesis that the presence of posterior ponticles markedly increases the incidence of rotational stenosis of vertebral arteries among chiropractic patients. To test this hypothesis, the incidence of rotational stenosis of vertebral arteries for chiropractic patients with at least 1 posterior ponticle was compared with the reported incidence of rotational stenosis among chiropractic patients in general.…”