Vertebral Artery Occlusion Following Hyperextension and Rotation of the Head

Abstract

Abstract:Vertebral Artery Occlusion Following Hyperextension and Rotation of the Head• This is a case report of a lateral medullary syndrome of Wallenberg following occlusion of one vertebral artery and stenosis of the opposite artery precipitated by combined motion of hyperextension, rotation, and lateral flexion of the head within physiological limits. Sufficient duration of such head position appeared to initiate thrombus formation following stenosis or occlusion of the vertebral artery at the level of the atlanto-occipital joint. Propagation of this thrombus obstructed the posterior inferior cerebellar artery causing infarction of the lateral medullary region. The pathogenesis of this mechanism is discussed. Additional Key WordsWallenberg syndrome vertebral artery thrombosis posterior inferior cerebellar artery atlanto-occipital joint However, the mechanism of arterial occlusion, thrombosis, and infarction has not been clarified from postmortem or clinical findings. 6This article presents a description of a lateral medullary syndrome following sustained physiological hyperextension, rotation, and lateral flexion movements of the head for a period of several hours. The angiographical survey demonstrated complete obstruction of the right vertebral artery associated with severe stenosis of the vertebral artery on the left. The clinical course and angiographical abnormalities provide an interesting sequence of events which suggest a probable mechanism of progression for this type of vascular occlusion. Case ReportA 43-year-old left-handed male draft designer experienced occasional nonvertiginous dizziness for two years. On March 21, 1974, he painted the ceilings of two rooms in his home, beginning in the early morning and finishing in the late afternoon. While painting, he used a roller or brush in his left hand. Therefore, his head was maintained in hyperextension, rotated to the left, and tilted to the right. Occasionally he used his right hand while his head remained hyperextended, rotated to the right, and tilted to the left. During that afternoon, he noted occasional dizziness as he used his right hand. The remainder of the day was not unusual and he was in no particular distress. The next morning, From the Division of Neurosurgery, Department of Neurology, University of Iowa College of Medicine, Iowa City, Iowa 52242. however, on March 22, 1974, he experienced an abrupt onset of severe headache, unsteadiness, numbness of the right side of his face, difficulty swallowing, and loss of taste on the right side of the tongue. As he attempted to climb into bed, he fell to the floor with marked loss of balance, but noted no change in level of consciousness. On March 23rd he was admitted to a local hospital where his ataxia and headache increased gradually. On admission to University of Iowa Hospitals on March 28th, examination revealed an alert and well-oriented man with a blood pressure of 140/80 mm Hg. The cranial nerve examination revealed absence of corneal reflex, and marked impairment of sensation to touch ...

Vertebrobasilar ischemia after neck motion.

“…Table 1 summarizes details of reported cases. 5 -712 - 25 Patients in our series had a mean age of 39.3 ±8.7 years; sexes were equally represented (51% females, 49% males). Symptoms were often (47%) accompanied by head or neck pain and homolateral to the side of the lesion.…”

Cervical vertigo and dizziness after whiplash injury

“…One of the major causes of cervical vertigo is vertebrobasilar insufficiency (VBI) [11,17]. However, imaging diagnosis is difficult and was especially difficult before the introduction of the MRI technique.…”

Carotid and Vertebral Artery Injury following Severe Head or Cervical Spine Trauma

“…Injury to the vertebral artery has been reported following penetrating injuries of the neck [20, 21], chiropractic manipulation [22, 23], prolonged abnormal positioning of the neck [24], birth trauma [25]or from closed head and neck trauma. Cervical spine injury may lead to stretching and tearing of the vertebral artery which is tethered to the bone at different locations in its intravertebral course.…”

“…Some authors regard hyperextension of the head with or without rotation and lateral flexion, other authors distraction-flexion injury resulting in unilateral or bilateral facet joint dislocation as the main risk factor [24, 26, 27]. Other possible risk factors reported are lateral dislocation as well as transverse process fracture [28, 29].…”