Wake-up stroke in a young woman with rotational vertebral artery occlusion due to far-lateral cervical disc herniation

Abstract

<jats:p>Wake-up stroke is most likely to be caused by small-vessel disease, and is related to snoring. The authors present a rare case of far-lateral cervical disc herniation with neck rotation, resulting in wake-up stroke in a young woman. The patient, a 31-year-old woman, was admitted to the hospital because of dysarthria and confusion when she awoke in the morning. Brain MRI showed acute infarction in the posterior fossa. Cerebral angiography showed thrombus in the distal top of the basilar artery and the bilateral posterior cerebral arteries. During angiography, the thrombus size decreased with heparinization. There was severe stenosis of the right vertebral artery (VA) at C5–6, and head rotation to the right resulted in complete occlusion of the right VA. Neck MRI showed far-lateral intervertebral disc herniation. Surgical decompression of the VA was performed via the anterior cervical approach. Histological examination showed a degenerative intervertebral disc. Postoperative angiography confirmed successful decompression of the VA.</jats:p>

Repeated cerebellar infarction in the affected nondominant vertebral artery distribution with reversible vertebral artery occlusion elicited by head tilt: illustrative case

“… 14 Among these cases, BHS caused by thromboembolism without VA dissection was extremely rare in patients with degenerative cervical spondylosis. 9 , 10 , 14 Such a condition was reported in two patients with wake-up stroke in the PICA distribution: ipsilateral in one patient and contralateral to the affected nondominant right VA in the other. 9 , 10 The affected nondominant right VA was stenotic at C4–C5 or C5–C6 in the neutral position but completely occluded with head rotation to the right.…”

“… 9 , 10 , 14 Such a condition was reported in two patients with wake-up stroke in the PICA distribution: ipsilateral in one patient and contralateral to the affected nondominant right VA in the other. 9 , 10 The affected nondominant right VA was stenotic at C4–C5 or C5–C6 in the neutral position but completely occluded with head rotation to the right. 9 , 10 However, in our patient, repeated cerebellar infarction was not a wake-up stroke, and the nondominant right VA was not stenotic in the neutral head position ( Fig.…”

“… 9 , 10 The affected nondominant right VA was stenotic at C4–C5 or C5–C6 in the neutral position but completely occluded with head rotation to the right. 9 , 10 However, in our patient, repeated cerebellar infarction was not a wake-up stroke, and the nondominant right VA was not stenotic in the neutral head position ( Fig. 4D ), although complete occlusion of the right VA was induced by head tilt to the right ( Fig.…”

“…An anterior approach is often used to remove osteophytes at C4–C6. 1 , 2 , 4 , 9 , 10 , 14 , 19–21 PICA-to-PICA bypass surgery has also been performed in a patient. 22 Recently, successful endovascular treatment with angioplasty and stenting for contralateral VA stenosis was reported as an attempt to augment collateral flow.…”

Subaxial Vertebral Artery Rotational Occlusion Syndrome: An Overview of Clinical Aspects, Diagnostic Work-Up, and Surgical Management

“…The addition of a posterior instrumented fusion is sel-dom necessary and is necessary only if instability is noted or the compression is due to other causes, such as a disc herniation or spondylolisthesis [11,24,25,34,44,48]. Most authors recommend simple lateral extension of the classic Smith-Robinson (Bailey-Cloward) technique [68][69][70] as suitable to expose the prevertebral musculature and VA [13,14].…”