Rotational vertebral artery syndrome (original) (raw)
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Contribution of intracranial vertebral artery asymmetry to vestibular neuropathy
Journal of Neurology, Neurosurgery & Psychiatry, 2011
Objectives To test the hypothesis that vertebral artery hypoplasia (VAH) may affect the lateralisation of vestibular neuropathy (VN), probably through haemodynamic effect on the vestibular labyrinth. Methods 69 patients with unilateral VN were examined with a magnetic resonance angiographic (MRA) and caloric test. 50 healthy subjects served as controls. The diagnosis of intracranial VAH was based on MRA if <0.22 cm in VA diameter and a diameter asymmetry index >40%. The authors then correlated the canal paretic side with the VAH side. Results MRA study revealed 29 VAH (right/left: 23/6) in VN subjects and six VAH in controls (right/left: 5/1). The RR of VAH in VN subjects compared with controls was elevated (RR¼2.2; 95% CI 1.8 to 2.8). There was a high accordance rate between the side of VAH and VN. Among 29 patients with unilateral VAH, 65.5% (N¼19) had an ipsilateral VN, in which left VAH showed a higher accordance rate (83.3%) than the right side (60.9%). VN subjects with vascular risk factors also had a higher VAH accordance rate (81%) than those without (25%). Conclusions VAH may serve as a regional haemodynamic negative contributor and impede blood supply to the ipsilateral vestibular labyrinth, contributing to the development of VN, which could be enhanced by atherosclerotic risk factors and the leftsided location.
Medical science monitor : international medical journal of experimental and clinical research, 2004
The aim of our study was to identify congenital morphological abnormalities of distal vertebral arteries (CMADVA) and their association with cerebral hypoperfusion leading to vertigo, and the role of MR and MRA in the diagnosis of vertebrobasilar (VB) abnormalities. 768 patients who complained of dizziness and/or vertigo were included in the study and evaluated by MR and MRA. CMADVAs were determined in 88 of the cases with no other explanation for vertigo and dizziness. 150 patients without dizziness or vertigo were used as a control group. The 3D TOF (Time- of- flight) MR angiographic technique was used. CMADVAs were detected in 88 of 768 patients (11.5%) with vertigo and/or dizziness. We also detected CMADVAs in 4 (2.7%) of 150 persons in the control group. The patients with abnormal vertebral artery findings were classified into ten categories. Lacunar infarcts in the brain stem were found in 8 patients after long-duration vertigo attacks. There was significant correlation betwee...
International Journal of Morphology
The presented case characterizes an association of primitive and definitive arteries with variations on the cadaveric brain base of a very old man. This case is found by the retrospective review of the data archive obtained during many years of cooperation of the author and co-authors. Fenestration of the (ectatic) basilar artery, partial and total duplication of some cerebellar arteries was associated with other variations of the vertebrobasilar and carotid systems. Although this is a case autopsied because of the myocardial infarction, the peculiarity of the case lies in the absence of the aneurysm based on the fenestration or dissection of one of the cerebral arteries.
The Egyptian Journal of Otolaryngology
Background Symptomatic medulla oblongata compressing lesions due to dilated vertebral artery are rare in the literature. The symptoms are extremely heterogeneous and not correlated to the severity of compression in many cases. Case presentation This paper describes two cases with vertebral artery compression of medulla oblongata complaining only from dizziness without any other neurological symptoms or signs. In both cases, videonystagmography revealed positional nystagmus. Head magnetic resonance imaging showed abnormal dilatation, elongation, and tortuosity of the vertebral artery compressing the medulla oblongata. Vestibular rehabilitation was described in both cases and had a significant effect on symptom improvement. Conclusion In the study cases, the sense of vertigo and/or unsteadiness is due to vertebral artery compression of medulla oblongata and can be an isolated symptom. Positional nystagmus is the only sign in vestibular evaluation.
Neurosurgical Focus, 2015
M anipulation of the neck was first implicated as a potential source of vertebral artery compression in 1947. 30 Manipulation-induced compression can occur through various mechanisms; rotation, extension, or flexion of the neck may also cause compression. 40 Extrinsic compression of the vertebral artery by osteophytes during head rotation was demonstrated initially in cadaveric specimens 18,40 and subsequently in living patients. 17,34 The atlas loop segment of the extracranial vertebral artery is susceptible to mechanical compression when the neck is rotated toward the contralateral side. 1 This can result in hindbrain ischemia and/or vessel injury. 1,13,33 The resulting vertebrobasilar insufficiency can cause syncope or near syncope, blurred vision, dizziness, vertigo, drop attacks, tinnitus, hypacusis, and sensory or motor deficits. 27,40 The symptoms are typically alleviated once the head is returned to a neutral position. 27,38,40 Sorensen, 35 in 1978, initially described the phenomenon of a reversible neurological deficit after head turning (bow hunter's syndrome) in a patient who suffered a posterior fossa stroke after archery practice. We present various symptomatic cases of vascular pa-ABBREVIATIONS CCJ = craniocervical junction; PICA = posterior inferior cerebellar artery.