Vertebral Artery Hypoplasia and Posterior Circulation Infarction in Patients with Isolated Vertigo with Stroke Risk Factors

Zhang, Dao Pei; Lu, Gui Feng; Zhang, Jie Wen; Zhang, Shu Ling; Qian, Kun; Yin, Suo

doi:10.1016/j.jstrokecerebrovasdis.2016.09.020

Cited by 14 publications

(13 citation statements)

References 22 publications

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“…However, there have been extremes of incidences reported previously in the literature. For instance, Zhang et al [46] reported that 64 of 245 patients (26%) had VAH as defined by the luminal diameter of a VA ≤ 2 mm. Ideally normative data and diagnostic criteria must be population-specific and sometimes patient-specific because VA diameter showed a significant dependence on sex as well as anthropometric parameters (height) [11].…”

Section: Discussionmentioning

confidence: 99%

“…VAH is not rare in the normal population [25], and is frequent in patients with non-cardioembolic posterior circulation ischaemic events rather than in asymptomatic patients [11]. As a consequence, researchers have provided evidence which suggest that people with VAH may have a high probability of posterior circulation strokes [46], with atherosclerotic susceptibility and ipsilateral lesions in the VA territory, partly because the smaller of paired arteries are more vulnerable to occlusion [20,25].…”

Section: Discussionmentioning

confidence: 99%

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The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery

Guan

Zilundu

et al. 2019

Folia Morphol

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Background: The aim of the study was to probe the morphological features of the proximal segment (V1) of vertebral artery (VA) in a sample of Chinese cadavers. Materials and methods: The origin, course and outer diameter at origin of the pre-vertebral part of the VAs were evaluated in 119 adult cadavers. Results: It was found that 94.12% of the VAs originated from the subclavian arteries, bilaterally. The variant origins were present in 5.88% of the cadavers and all originated directly from the arch of the aorta. All the variations were observed on the left side of male cadavers. The average outer diameters at origin of the normal and variation groups were 4.35 ± 1.00 mm and 4.82 ± ± 1.42 mm, respectively, p = 0.035. In the normal group, but not in the variation group, the average diameter in the males was significantly larger than that in the females (4.50 ± 0.99 mm, 3.92 ± 0.92 mm, respectively, p = 0.000). In addition, only 5 cadavers in the normal group had hypoplastic VAs (4.20%, 4 males,. Vertebral artery dominance (VAD) was present in 91 (69 males) out of 112 cadavers and more common on the left (n = 48). In addition, 3 cadavers satisfied conditions for coexistence of VAD and vertebral artery hypoplasia. All 7 cadavers in the variation group exhibited VAD, which was more common on the right side (n = 5). Conclusions: The morphologic variations and frequencies described above have implications for the early prevention, abnormal anatomy detection, accurate diagnosis, safe surgery and endovascular treatment of cardiovascular and neurological disease. (Folia Morphol 2019; 78, 4: 710-719)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery

Guan

Zilundu

et al. 2019

Folia Morphol

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“…Hypoplasia and arteriosclerosis stenosis of the vertebral artery are commonly associated with ischemic stroke, especially accompanied with other risk factors (Katsanos, Kosmidou, & Kyritsis, 2013; Park, Kim, & Roh, 2007; Zhang et al., 2017). In our study, 65.2% of patients with acute vertigo or dizziness due to cerebral infarction had vertebral artery abnormalities, which was significantly higher than that found in the noninfarction group.…”

Section: Discussionmentioning

confidence: 99%

“…The vascular dizziness were associated with age >60 years old, accompanying imbalance and focal neurological deficits (Navi et al., 2012). Researches also suggested that vertebral artery hypoplasia, posterior circulation stenosis, and diabetes were correlated with stroke (Mosarrezai, Toghae, Majed, & Aloosh, 2012; Zhang et al., 2017). If a misdiagnosis occurs, patients may deteriorate resulting in permanent disability or a life‐threatening course.…”

Section: Introductionmentioning

confidence: 99%

Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction

et al. 2018

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ObjectiveTo clarify the relationship of clinical factors with isolated vertigo or dizziness of cerebrovascular origin.MethodsClinical data of patients admitted in East Hospital from Jan. 2015 to Apr. 2016, whose complaint were acute vertigo or dizziness were retrospectively collected. All patients arrived at the emergency department within 24 hr of symptom onset, had no acute ischemic lesion first CT and NIHSS score of 0. Patients were divided into cerebral infarction group and noncerebral infarction group according to subsequent cerebral imaging results and clinical and laboratory factors related to cerebral infarction were analyzed.Result51.6% of patients were female (n = 141). 46 patients (16.8%) were diagnosed with acute cerebral infarction. Baseline demographic data of the two groups was not significantly different. Univariate analysis found that history of smoking (p = 0.009), headache (p = 0.028), unsteadiness (p = 0.009), neuron specific enolase (p = 0.001), and vertebral artery abnormalities found on imaging (p = 0.009) were the significant difference between two groups. Increased neuron specific enolase (p = 0.005) and an abnormal vertebral artery (p = 0.044) were significant on multivariate analysis.Conclusions16.8% of acute isolated vertigo or dizziness presentations were diagnosed with acute cerebral infarction. Increased serum neuron specific enolase and vertebral artery abnormalities were the strongest indicators of acute cerebral infarction.

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“…The artery of Percheron is a single unilateral vessel that supplies both sides of the medial thalamus, ischemia of which results in a bilateral thalamic stroke with significant mental status, memory, psychiatric, speech, and ocular symptoms (Figure D) . Vertebral artery hypoplasia is overrepresented in patients with posterior inferior cerebellar artery infarctions, which are usually ipsilateral to the hypoplastic vessel …”

Section: Discussion/observationsmentioning

confidence: 99%

Avoiding Misdiagnosis in Patients With Posterior Circulation Ischemia: A Narrative Review

Gurley

Edlow

2019

Academic Emergency Medicine

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Posterior circulation strokes represent 20% of all acute ischemic strokes. Posterior circulation stroke patients are misdiagnosed twice as often compared to those with anterior events. Misdiagnosed patients likely have worse outcomes than correctly diagnosed patients because they are at risk for complications of the initial stroke as well as recurrent events due to lack of secondary stroke prevention and failure to treat the underlying vascular pathology.Understanding important anatomic variants, the clinical presentations, relevant physical examination findings, and the limitations of acute brain imaging may help reduce misdiagnosis. We present a symptom-based review of posterior circulation ischemia focusing on the subtler presentations with a brief discussion of basilar stroke, both of which can be missed by the emergency physician. Strategies to avoid misdiagnosis include establishing an abrupt onset of symptoms, awareness of the nonspecific presentations, consideration of basilar stroke in altered patients and using a modern approach to diagnosis of the acutely dizzy patient.

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Vertebral Artery Hypoplasia and Posterior Circulation Infarction in Patients with Isolated Vertigo with Stroke Risk Factors

Cited by 14 publications

References 22 publications

The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery

The applied anatomy and clinical significance of the proximal, V1 segment of vertebral artery

Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction

Avoiding Misdiagnosis in Patients With Posterior Circulation Ischemia: A Narrative Review

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