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Article in Chinese | WPRIM | ID: wpr-923387


@#Objective    To investigate the treatment of modified vertebral-carotid transposition (VCT) in patients with severe stenosis or occlusion at V1 segment of vertebral artery. Methods    A retrospective study of 13 patients with severe stenosis or occlusion at V1 segment of vertebral artery treated by modified VCT in our hospital from October 2016 to December 2018 was done. There were 10 males and 3 females with an average age of 70.5±7.1 years. Results    The operation was successful in this series of patients. The follow-up duration was 1-3 years. The stenosis degree of the V1 segment of the vertebral artery decreased from 86.8%±7.5% to 17.4%±14.5%. All patients achieved remission of symptoms after the surgery. Temporary peripheral nerve injury occurred in 6 patients. Four patients with neurological complications relieved during follow-up. The patency rate was 100.0% at postoperative 1 and 3 years. There was no perioperative death, stroke or re-intervention. Conclusion    Modified VCT can precisely restore the distal blood flow of patients with severe stenosis or occlusion at V1 segment of vertebral artery, and relieve their symptoms.

Arq. bras. neurocir ; 40(3): 242-252, 15/09/2021.
Article in English | LILACS-Express | LILACS | ID: biblio-1362144


Even though traumatic dissection of cervical arterial vessels is themajor cause of stroke among adults, it is still an underdiagnosed disease in neurosurgical emergencies, since most patients do not have or present subtle clinical signs in the acute phase. The authors report two interesting cases of cervical artery dissection with different traumatic mechanisms and present a broad literature review about this subject.

Chinese Journal of Radiology ; (12): 948-954, 2021.
Article in Chinese | WPRIM | ID: wpr-910257


Objective:To explore high-resolution MRI (HR-MRI) characteristics in patients with ischemic stroke caused by vertebral artery dissection.Methods:A total of 47 patients with suspected vertebral artery dissection in the First People′s Hospital of Lianyungang, Kangda College, Nanjing Medical University from June 2015 to June 2020 were consecutively enrolled. All patients underwent routine MRI before HR-MRI, and three-dimensional arterial spin labeling (3D-ASL) was performed in those with negative MR. Patients with posterior circulation infarction on MRI and ischemic hypoperfusion on 3D-ASL were included in the ischemic stroke group, while patients with negative plain MRI and normal 3D-ASL were included in the normal group. The clinical characteristics and HR-MRI imaging characteristics between the two groups were compared using t-test or χ 2 test, while the correlations of quantitative data or ranked data were analyzed by Pearson or Spearman test. Results:There were 27 patients in the ischemic stroke group and 20 patients in the normal group, and there were no significant differences in clinical characteristics such as gender, age, site of onset, history of hypertension, hyperlipidemia, and history of diabetes between the two groups ( P>0.05). Basilar artery lateral deviation classification (χ2 =7.013, P=0.030), basilar lateral bend angle (140°±19° vs. 137°±15°, t=2.231, P<0.026), minimum bending angle of vertebral basilar artery (131°±27° vs. 90°±13°, t=42.630, P<0.001), the minimum bending angle of vertebrobasilar artery ≤ 90° distribution (3 cases vs. 21 cases, χ2=15.240, P<0.001) and effective lumen index (0.33±0.10 vs. 0.17±0.09, t=35.934, P<0.001) of normal group and ischemic stroke group showed statistically significant differences. Among them, the minimum bending angle of the vertebrobasilar artery was negatively correlated with posterior circulation ischemic hypoperfusion ( r=-0.621, P<0.001), and the effective lumen index was negatively correlated with posterior circulation ischemic stroke ( r =-0.713, P<0.001). However, the location of the dissection, the distribution of hematoma, the shape of the lumen and the enhancement type were not statistically significant between the normal group and ischemic stroke group ( P>0.05). Conclusion:HR-MRI shows that the lateral deviation of the basilar artery of grade 3, the minimum bending angle of the vertebrobasilar artery less than 90°, and small effective lumen index are related to posterior circulation stroke caused by vertebral artery dissection, which may help for the proper formulation of clinical treatment plan.

Article in Chinese | WPRIM | ID: wpr-905926


Objective:To establish a model of cervical spondylosis of vertebral artery type (CSA) in rats by mixed modeling method, and observe the intervention effect of Panlongqi tablet (PLQT) on CSA rats. Method:SD rats were divided into a normal control group, a model group, low- (0.16 g·kg<sup>-1</sup>), medium- (0.32 g·kg<sup>-1</sup>), and high-dose (0.64 g·kg<sup>-1</sup>) PLQT groups, and a Jingfukang granule (JFK, 1.35 g·kg<sup>-1</sup>) group. The rats were treated correspondingly 24 hours after modeling for eight weeks, and those in the normal control group received an equal volume of normal saline by gavage. The limb movement was tested by the inclined plate assay, vertebral artery flow volume by multi-mode high-frequency sound wave for small animals, and microcirculatory blood flow in the pia mater by the laser Doppler. The imaging of the cervical spine was recorded and scored by X-ray micro-computed tomography (Micro CT). Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of endothelin-1 (ET-1), nitric oxide (NO), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor (PAI). Result:Compared with the normal control group, the model group showed decreased limb movement, vertebral artery flow volume, and microcirculatory blood flow in the pia mater, and increased imaging of the cervical spine and score (<italic>P</italic><0.05,<italic>P</italic><0.01). PLQT could dose-dependently improve the motor function, increase the vertebral artery flow volume and microcirculatory blood flow in the pia mater, and reduce the degree and score of imaging of the cervical spine in CSA rats(<italic>P</italic><0.05,<italic>P</italic><0.01). The serum levels of NO and t-PA were decreased and those of ET-1 and PAI were increased in the model group as compared with those in the normal control group, while such changes were reversed by PLQT treatment(<italic>P</italic><0.05,<italic>P</italic><0.01). Conclusion:PLQT can enhance the limb movement, promote the vertebral artery flow volume and microcirculatory blood flow in the pia mater, improve the degree of imaging of the cervical spine, regulate the vasomotor function, and improve the coagulation and fibrinolysis system of CSA rats, which shows good potential for the treatment of CSA.

Rev. Assoc. Med. Bras. (1992) ; 66(10): 1351-1354, Oct. 2020. graf
Article in English | LILACS, SES-SP | ID: biblio-1136158


SUMMARY Vertebral Artery Dissection (VAD) is a rare condition that can be caused by a wide amplitude of neck movement, which injures the vessel wall and can cause ischemia in the cerebellum. We present a 37-year-old man with herniated lumbar disc and allergic rhinosinusitis, which caused sneezing spells. After one of these bouts with a ricochet of the head, he presented C3 misalignment with local pain. Twenty-one days later, affected by a new crisis, he presented left temporal headache, nystagmus, and vertigo. After 3 days, Magnetic Resonance Imaging (MRI) identified 2 regions of cerebellar ischemia and filling failure of the right vertebral artery. After 2 days, Computed Angiotomography (CT Angiography) was performed and showed right VAD with a local thrombus, without aneurysmal signs. Transcranial Doppler did not indicate an increase in blood flow from this artery. The suggested treatment involved administration of anticoagulant Apixabana 5mg, 12/12h, for 3 months, until the condition was reevaluated with new Angio CT and MRI. It was recommended that the patient was released from work for 1 month and forbidden from doing intense physical exercises for 3 months; however, due to setbacks, these deadlines were extended until a new appointment, 4 months after the first visit. The new tests showed no changes, indicating that the condition was stable. This case aims to indicate the possible investigations of the diagnosis and therapeutic options of the rare association between VAD with cerebellar infarction in a well-documented case.

RESUMO A Dissecção da Artéria Vertebral (DAV) é quadro raro que pode ser causado por movimentação de grande amplitude do pescoço, que lesiona a parede desse vaso, podendo provocar isquemia no cerebelo. Apresentamos um homem de 37 anos, com hérnia de disco e rinossinusite alérgica que lhe causava crises de espirros em salva (CE). Após uma dessas crises com ricocheteamento da cabeça, apresentou desalinhamento de C3 com dor local. Vinte e um dias depois, acometido por nova crise, apresentou cefaleia temporal esquerda, nistagmo e vertigem. Decorridos 3 dias, o paciente foi submetido a Ressoânncia Magnética (RM), que identificou 2 regiões de isquemia cerebelar e enchimento comprometido da artéria vertebral direita. Após 2 dias, foram feitos Angiotomografia Computadorizada (Angio TC), que constatou DAV direita com trombo local, sem sinais aneurismáticos, e Doppler Transcraniano, que não indicou aumento do fluxo sanguíneo dessa artéria. O tratamento sugerido envolvia administração de anticoagulante Apixabana 5mg, 12/12h, por 3 meses, até que o quadro fosse reavaliado com novas Angio TC e RM. Foi recomendado que o paciente ficasse afastado do trabalho por 1 mês e de exercícios físicos intensos por 3 meses, porém devido a contratempos, esses prazos foram prorrogados até nova consulta, 4 meses após a primeira. Os novos exames não apresentaram alterações, indicando que o quadro estava estável. Esse caso tem como objetivo indicar as possíveis investigações do diagnóstico e opções terapêuticas da rara associação entre DAV com infarto cerebelar em caso bem documentado.

Humans , Male , Adult , Cerebellar Diseases , Vertebral Artery Dissection/etiology , Vertebral Artery Dissection/diagnostic imaging , Sneezing , Vertebral Artery , Magnetic Resonance Imaging , Infarction
Colomb. med ; 51(3): e504386, July-Sept. 2020. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1142824


Abstract Case Description: A 24-year-old male suffers from a motor vehicle accident with penetrating neck trauma and concomitant closed left cervicothoracic trauma. Clinical Findings: High impact trauma causing hypovolemic shock, left zone I penetrating neck trauma, ischemia due to blunt trauma to the axillary vessels, and brachial plexus injury. Transection of the vertebral artery on angiotomography. Diagnosed with scapulothoracic dissociation and vertebral artery trauma. Treatment and outcome: Axillary arteriovenous reconstruction, fasciotomies, non-surgical approach of the vertebral artery trauma, and deferred treatment of the brachial plexus trauma were performed. Survival of the patient and his limb, with major neurologic sequelae Clinical Relevance: The case presented here is an example of scapulothoracic dissociation with associated trauma to the vertebral artery, injuries that are uncommon and associated with high morbidity and mortality. Early recognition of the injuries and a multidisciplinary approach for this complex case by surgical board reviews at various levels within the course of care were key determinants in the patient's improved prognosis. This case report presents an analysis of the diagnostics, treatment, and course; considering in-hospital care and the decision-making process as determinants for the prognosis in a polytrauma patient.

Resumen Descripción del caso: Varón de 24 años que sufre accidente automovilístico con trauma penetrante de cuello y trauma cerrado cervico torácico izquierdo concomitante. Hallazgos clínicos: Shock hipovolémico, trauma en zona I cuello izquierdo, isquemia por trauma cerrado de vasos axilares y lesión por trauma cerrado del plexo braquial; producto de trauma de alto impacto. Sección de arteria vertebral por angiotomografia. Se diagnostica disociación escapulo-torácica y trauma de arteria vertebral. Tratamiento y resultado: Reconstrucción vascular arterio-venosa axilar, fasciotomías y abordaje no operatorio del trauma de arteria vertebral, con manejo diferido del trauma del plexo braquial. Sobrevida del paciente y su extremidad, con secuelas neurológicas mayores. Relevancia clínica: Es un caso de disociación escapulotorácica y lesión de arteria vertebral concomitante, siendo esta una asociación infrecuente y de alta morbi-mortalidad. El reconocimiento temprano de las lesiones y un abordaje multidisciplinario de este escenario de complejidad por medio de juntas quirúrgicas en varios niveles del proceso de atención, fueron determinantes para cambiar el pronóstico del paciente. Se presenta un análisis del diagnóstico, manejo y evolución; considerando el proceso de atención hospitalaria, toma consensuada de decisiones y el pronóstico en un paciente politraumatizado.

Article | IMSEAR | ID: sea-215108


So far, evaluation of vertebral arteries has been done by angiography with a limited data on evaluation with duplex scanning of the vertebral arteries. We wanted to study the radiological features and vertebral artery Doppler characteristics, in patients aged above 35 years with a clinical diagnosis of cervical spondylosis. METHODSThis is a case control study with a total of 120 subjects aged over 35 years (60 subjects were cases with the clinical diagnosis of cervical spondylosis and the remaining 60 subjects were age matched controls). Vertebral artery colour Doppler was performed to record peak systolic velocity, time averaged maximum velocity, diameter of the segment in grey scale in millimetres and flow volume of the vertebral artery. Statistical analysis was done using chi square test, student t test and z test with p values < 0.05 being considered statistically significant. RESULTSMajority of patients in both groups were in the age group 41 - 50 years. Among cases 39 (65%) were males and 21 (35%) were females. Most of cases had vertebral artery diameters in the range of 3.0 - 3.5 mm seen both on right [21{35%}] as well as on left side [17 {28.3%}], and a similar finding was observed in controls as well. No statistical significance was observed amongst cases and control on either right or left side. Most of the cases had vertebral artery blood flow in the range of 51-100 mL/min both on right side [26 (43.3%)] and left side [22 (36.7%). On comparing vertebral artery blood flow in the range of ≤100 mL/min and >100 mL/min, the difference was statistically significant on the left side. On comparing the number of cases and controls according to the vertebral artery blood flow velocity ≤30 cm/s and >30 cm/sec on right side, p value was 0.009 and that on the left was 0.001, both of which are statistically significant. CONCLUSIONSVertebral artery diameter is not a very reliable sign in this degenerative condition. Vertebral artery flow volume is decreased at least in one vertebral artery. Vertebral artery blood flow velocity was significantly reduced in cervical spondylosis cases compared to controls both on right side (p=0.009) and left side (p= 0.001). This makes reduced vertebral artery blood flow velocity as a very strong sign in this condition. To conclude vertebral artery ultrasound is a very useful and reliable tool in evaluation of vertebrobasilar insufficiency cases.

Rev. neuropsiquiatr ; 83(3): 198-202, jul-sep 2020. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1150078


Resumen El síndrome de Wallenberg es el accidente cerebrovascular isquémico más común de la circulación posterior, causado por una obstrucción aterotrombótica en la arteria vertebral o la arteria cerebelosa posteroinferior. Esta oclusión origina una isquemia en la porción lateral del bulbo que resulta en la triada representativa del síndrome de Horner, ataxia ipsilateral a la lesión y alteraciones sensitivas. El riesgo de padecer este cuadro es mayor si se tiene variaciones anatómicas tales como una arteria vertebral hipoplásica y/o duplicada. Se presenta el caso de una mujer de 45 años admitida por hipoestesia en el lado derecho del rostro y en el hemicuerpo izquierdo, así como disfagia y vómitos. La resonancia magnética reveló una lesión isquémica en la zona bulbar lateral derecha; en la angiorresonancia se evidenció una arteria vertebral derecha hipoplásica, en tanto que la angio-TEM del cuello mostró una arteria vertebral derecha hipoplásica y bifurcada. En base a la clínica y exámenes radiológicos se confirmó el diagnóstico de Síndrome de Wallenberg, causado por isquemia en el territorio de la arteria vertebral derecha hipoplásica bifurcada.

Summary Wallenberg syndrome is the most common ischemic stroke of the posterior circulation, caused by an atherothrombotic obstruction of the vertebral or the postero-inferior cerebellar artery. This occlusion leads to ischemia in the lateral portion of the bulb, which results in the representative triad of Horner's syndrome, ataxia on the ipsilateral side of the lesion and sensory alterations. There is a greater risk of suffering from this condition with anatomical variations such as a hypoplastic and/or duplicated vertebral artery. The case of a 45-year-old woman admitted as an emergency due to hypoesthesia on the right side of the face and on the left side of the body, as well as dysphagia and vomiting is reported. MRI studies revealed an ischemic lesion in the right-side of the bulbar area; in the angio-MRI a hypoplastic right vertebral artery was evidenced whereas the angio-TC showed a hypoplastic and duplicated right vertebral artery. On the basis of the clinical and radiological examinations, the diagnosis of Wallenberg syndrome caused by bifurcated hypoplastic right vertebral artery ischemia, was confirmed.

Int. j. morphol ; 38(1): 140-146, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1056412


The aim of this study was to establish safety ranges for the third vertebral artery segment (V3) for craneocervical procedures. Injury to V3 represents a potentially catastrophic complication. Its tortuous path and complex relationship with neighboring structures, increasing the risk. Ten male adult cadavers (20 vertebral arteries) with arterial infiltration of red latex were studied. The length, angles and anatomical measurements were obtained between the selected surgical landmarks and the portions of V3 segment. The horizontal portion has a length of 32.7 ± 3.6 mm with an angulation of 115.1 ± 8.3 degrees. The mean distances of the horizontal portion were: from the midline to the V3 groove of C1 posterior arch (24.7 ± 6.3 mm); from C1 pars interarticularis to the V3 distal loop of V3 (8.9 ± 1.4 mm). The vertical portion has a length 32.5 ± 5.6 mm with an angulation of the proximal loop of 113.6 ± 5.8 degrees. The mean distances between the C2 spinous process to the medial surface of the distal loop (43.8 ± 4.2 mm); from the C1-C2 joint to the V3 vertical portion (9.5 ± 1.5 mm); from C2 pars interarticularis to V3 in the C2 transverse foramen (6.5 ± 3.4 mm); from C2 pars interarticularis to V3 in the C1 transverse foramen (17.5 ± 4.5 mm). We reported four potential sites where V3 can be injured during four different surgical procedures: exposure of the posterior arch of C1, and pars interarticularis of C1 in the horizontal portion and exposure of the C1C2 joint, and placement of C1-C2 transarticular screws one in the vertical portion. We provide measurements of redundancy and safety ranges to reduce the risk of injury to the V3 segment during craniocervical surgical procedures.

El objetivo de este estudio fue establecer rangos de seguridad en el tercer segmento de arteria vertebral (V3) para cirugías de la región craneocervicales. La lesión de V3 representa una complicación potencialmente catastrófica. Su tortuoso trayecto y compleja relación con las estructuras aledañas, aumenta el riesgo. Se estudiaron diez cadáveres adultos masculinos (20 arterias vertebrales) con infiltración arterial de látex rojo. La longitud, ángulos y medidas anatómicas se obtuvieron respecto a los puntos de referencia quirúrgicos y las porciones del segmento V3. La porción horizontal tiene una longitud de 32,7 ± 3,6 mm con una angulación de 115,1 ± 8,3 grados. Las distancias medias de la porción horizontal fueron: desde la línea media hasta el surco V3 del arco posterior C1 (24,7 ± 6,3 mm); desde C1 pars interarticularis hasta el bucle distal V3 de V3 (8,9 ± 1,4 mm). La parte vertical tiene una longitud de 32,5 ± 5,6 mm con una angulación del bucle proximal de 113,6 ± 5,8 grados. Las distancias medias entre el proceso espinoso C2 y la superficie medial del bucle distal (43,8 ± 4,2 mm); desde la unión C1-C2 hasta la porción vertical V3 (9,5 ± 1,5 mm); de C2 pars interarticularis a V3 en el foramen transversal C2 (6,5 ± 3,4 mm); de C2 pars interarticularis a V3 en el foramen transversal C1 (17,5 ± 4,5 mm). Informamos cuatro sitios potenciales donde la V3 puede lesionarse durante cuatro procedimientos quirúrgicos diferentes: exposición del arco posterior de C1 y pars interarticularis de C1 en la porción horizontal y exposición de la articulación C1-C2, y colocación de C1-C2 Tornillos transarticulares uno en la porción vertical. Proporcionamos mediciones de los rangos de redundancia y seguridad para reducir el riesgo de lesiones en el segmento V3 durante procedimientos quirúrgicos craneocervicales.

Humans , Middle Aged , Vertebral Artery/anatomy & histology , Cadaver , Cervical Vertebrae/anatomy & histology , Cross-Sectional Studies
Article | IMSEAR | ID: sea-198685


Introduction: The atlas, the first cervical vertebra, supports the head. It is unique in that it fails to incorporate acentrum. Because it supports the skull, it was named after Atlas who, according to Greek mythology, supportedthe earth on his shoulders. Frequently bony spurs arise from the anterior and posterior margins of the groove forthe vertebral artery. These are sometimes referred to as Ponticles, and they occasionally convert the groove intoa foramen. More often the foramen is incomplete superiorly. Arcuate foramen also known as ponticulus posticus(Latin for “little posterior bridge”).Aims and Objectives: To study the proportion and various types of ponticuli.Materials and methods: Present study was conducted on 100 adult human atlas vertebrae, collected from thedepartment of Anatomy, Mysore Medical College and Research Institute, Mysuru.Observations and Results: Out of 100 atlas vertebrae examined, 20 atlas vertebrae showed ponticuli of varioustypes. 27 Ponticuli was observed in twenty (20) atlas vertebra as follows: a) Ponticulus posticus -15. b) Ponticuluslateralis -07. c) Ponticulus posterolateral -05. d) Complete Ponticulus -11. e) Incomplete Ponticulus -16.e) Bilateral Ponticulus -07. f) Unilateral Ponticulus -13. g) Right side -17 and Left side -10.Conclusion: Proper identification of this anomaly on preoperative lateral radiographs should alert the surgeonto avoid using the ponticulus as a starting point for a lateral mass screw in order to not injure the vertebralartery. It is also useful to surgeons who face regularly the patients complaining about the symptoms ofvertebrobasilar insufficiency like headache, vertigo, migraine.

Article in Chinese | WPRIM | ID: wpr-860922


Imaging diagnosis of intracranial vertebral artery dissection aneurysm (VADA) is difficult due to its deep location and complex lesion structure. Conventional MRI is difficult to accurately observe and evaluate VADA, while high resolution MRI (HRMRI) has high spatial and tissue resolution, and vascular wall imaging technology can directly display the structural and pathological changes of the vessel wall, which plays an important role for the diagnosis of VADA and the evaluation of prognosis. The application progresses of HRMRI in VADA was reviewed in this article.

Article in Chinese | WPRIM | ID: wpr-855930


The etiology of posterior circulation ischemic stroke caused by bilateral vertebral artery dissection ( VAD) is often difficult to detect. In this study, the authors report a case of posterior circulation ischemic stroke with a history of excessive back elevation of the neck. The dissection of bilateral vertebral arteries was detected by carotid Doppler ultrasonography and further confirmed by magnetic resonance imaging and high-resolution magnetic resonance imaging. After 6 months of standard administration of dual antiplatelet therapy, recanalization of the bilateral vertebral artery was achieved. It proves that the early diagnosis and standardized medical treatment of VAD can significantly improve patients' prognosis.

Article in Japanese | WPRIM | ID: wpr-825929


A fifty-seven-year-old male farmer with a history of cerebral infarctions twice in the past without any functional disability stopped prescribed antithrombotics and regular medical follow-up. He had sudden left hemiplegia after the work, and was taken to our hospital. A contrast-enhanced computed tomography (CT) scan showed infarction at the right basal ganglia, occlusion of the internal carotid artery and the left vertebral artery, and mural thrombus in the ascending aorta. Mural thrombus in the ascending aorta was suspected to be the causative thrombus of other infarctions. He was started on continuous heparin infusion on the day of presentation, and had ascending aortic replacement surgery on day 24. No perioperative complication was confirmed. He was extubated on postoperative day (POD) 1, and was transferred to another rehabilitation hospital with almost no functional disability. No thrombotic event was confirmed as of POD 180.

Neurology Asia ; : 225-229, 2020.
Article in English | WPRIM | ID: wpr-877220


@#Wallenberg syndrome (lateral medullary syndrome) is a type of posterior circulation stroke resulting in brainstem infarction which is most often caused by occlusion of vertebral artery or posterior inferior cerebellar artery or both.1 Here we report a case of right lateral medullary syndrome secondary to vertebral artery occlusion with associated left cerebellar and cervical cord infarct resulting in quadriparesis.

Medisan ; 23(5)sept.-oct. 2019. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1091136


Se describe el caso clínico de un anciano de 85 años de edad a quien se le diagnosticó síndrome de Barré-Lieou en el Hospital Provincial General Docente Dr. Antonio Luaces Iraola de Ciego de Ávila, por lo cual fue atendido en consultas multidisciplinarias. Mediante la radiografía contrastada del esófago se observó compresión extrínseca de su tercio distal por grandes osteofitos cervicales anteriores, así como estrechamiento anterior y posterior desde la cuarta hasta la séptima vértebras cervicales; asimismo, las imágenes de la resonancia magnética de cráneo y columna cervical permitieron comprobar la presencia de complejos disco-osteofitos de vértebras cervicales con edema óseo, de carácter compresivo. Se comenta sobre el tratamiento empleado y se ofrecen las sugerencias terapéuticas de los expertos en el tema.

The case report of a 85 years elderly to whom the Barré-Lieou syndrome was diagnosed in Dr. Antonio Luaces Iraola Teaching General Provincial Hospital in Ciego de Ávila is described, reason why he was assisted in multidisciplinary visits. By means of the contrasted x-ray of the esophagus, extrinsic compression of his distal third was observed caused by huge anterior cervical osteophytes, as well as early and posterior narrowing of the fourth to the seventh cervical vertebrae; also, the magnetic resonance images of skull and cervical spine allowed to check the presence of disk-osteophytes complexes of cervical vertebrae, with bony edema, of compressive character. It is commented on the used treatment and the therapeutic indications of experts in the topic are offered.

Vertebral Artery , Aged , Posterior Cervical Sympathetic Syndrome
Rev. bras. ortop ; 54(5): 605-608, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1057931


Resumo The posterior inferior cerebellar artery usually arises from the intracranial segment (V4) of the vertebral artery. Despite its mean diameter of 2 mm, it usually irrigates important areas of the brain. When occluded, whether due to trauma or surgery, it may cause infarction in the brain stem and cerebellum. The present report describes a case of incidental finding of a posterior inferior cerebellar artery arising from the cervical segment (V3) of the vertebral artery, demonstrated by angiography. The findings were recorded and compared to those of earlier publications. Brief explanations regarding anatomy, vascular anomalies and embryology were provided. A literature review showed that anomalous branches of the cervical segment of the vertebral artery are infrequent andmust be known. A better understanding of anatomy and its variations enables an accurate topographic diagnosis, as well as the planning of the optimal surgical approach and therapy. Knowledge of this anatomical variation is essential because, if it is mistaken for a muscle branch and coagulated, this can cause ischemia and disabling sequelae.

Resumo A artéria cerebelar inferoposterior geralmente nasce do segmento intracraniano (V4) da artéria vertebral. Apesar de ter diâmetro médio de 2 mm, usualmente irriga áreas eloquentes do encéfalo. Quando ocluída, seja por trauma ou cirurgia, pode causar infarto no tronco encefálico e no cerebelo. Apresentamos um caso de artéria cerebelar inferoposterior com origem anômala no segmento cervical (V3) da artéria vertebral, demonstrado por angiografia. Os resultados foram registrados e comparados com os de publicações anteriores. Foram fornecidas breves explicações sobre a anatomia, anomalias vasculares e embriologia. A revisão da literatura mostrou que os ramos anômalos do segmento cervical da artéria vertebral são infrequentes e devem ser conhecidos. Uma melhor compreensão da anatomia e suas variações permite fazer um diagnóstico topográfico preciso, bem como planejar a abordagem e a terapia cirúrgicas ideais. O conhecimento dessa variação anatômica é essencial, pois, se confundida com um ramo muscular e coagulada, pode causar isquemia com sequelas incapacitantes.

Humans , Male , Middle Aged , Vertebral Artery , Lateral Medullary Syndrome , Brain Stem , Cerebral Angiography , Angiography , Anatomic Variation , Intraoperative Complications
Article | IMSEAR | ID: sea-198577


Background: The lateral outgrowth from the superior articular facet(SAF) to the posterior root of the transverseprocess of the atlas forms the partial lateral bridge(PLB) and when complete forms the supratransverse foramen(STF). Presence of such bridges may predispose to vertebrobasilar insufficiency. Since there are fewer studies onthe lateral bridge therefore the present study was aimed to know the incidence of lateral bridges and STF and alsoto know the dimensions of STF as the knowledge about such dimensions helps in interpretation of radiologicalfindings, provide guidance for neurosurgical intervention.Materials and methods: A total of 80 undamaged, dry human atlas vertebrae were obtained from the Departmentof Anatomy, Government Medical College and SGRDIMSAR, Amritsar, Punjab, India. The Partial lateral bridge(PLB)and Supratransverse Foramen(STF) were identified following the criteria used by Mitchell (1998a, 1998b).Measurements were taken of the maximum dimensions of the STF in (Supero-inferior and Medio-lateral planes)and ipsilateral Foramen Transversarium (FT) in (Ventro-dorsal and Medio-lateral planes). The cross-sectionalarea of STF and ipsilateral FT was calculated.Results: Total 7 (8.75%) lateral bridges in atlas vertebrae occurred. 6 (7.5%) lateral bridges occurred in associationwith the posterior bridges and 1(1.25%) isolated partial lateral bridge occurred on the left side. Partial lateralbridges were found in 2 bones(2.5%) on right side and 4(2.5%)bones on left side. 1 (0.625%) Complete lateralbridges forming STF was observed on right side. Rt. Supra-Transverse Foramen Height (STFH) and Width (STFW)was found to be 5.4mm and 6.2mm. Ipsilateral Foramen Transversarium Length (FTL) and Width (FTW) was foundto be 6.4mm and 5.9mm. The cross-sectional area of Rt. STF was 26.28mm2 and the cross-sectional area ofipsilateral FT was 29.64mm2 and ipsilateral FT area was smaller than STF.Conclusion: The findings in the present study indicate a higher prevalence of lateral bridges on the left side.Difference in the cross sectional area of STF and ipsilateral FT may lead to compression of V.A and this compressionbecomes evidently symptomatic in extreme manipulations of the neck. Patients presenting with vertebrobasilarinsufûciency or cervicogenic syndromes should be evaluated to explore the possibility of the presence of lateralatlas bridges as etiological factor

Article | IMSEAR | ID: sea-210964


To find the incidence of accessory foramen transversarium in dried cervical vertebrae. 150 dried cervicalvertebrae were collected from Postgraduate department of Anatomy Government Medical College Jammuand examined for the accessory foramen transversarium.Out of 150 cervical vertebrae, only 24 hadaccessory foramen transversarium with preponderance in sixth cervical vertebrae. Amongst the vertebraewith accessory foramen transversarium, 14 were bilateral and 10 were unilateral. In the present study theincidence of accessory foramen transversarium was 16%. This is important for Radiologists to interpretComputed Tomography Images and Magnetic Resonance Imaging of cervical spine.

Article | IMSEAR | ID: sea-202293


Introduction: Vertebral artery dissection (VAD) is animportant cause of posterior circulation stroke in youngpatients and presents with a host of clinically varied symptomsdepending upon the type and site of dissection. Currentresearch aimed to study the spectrum of magnetic resonanceimaging findings in vertebral artery dissection.Material and methods: This was an observational studywhere a cohort of 193 patients of posterior circulation strokewere evaluated with magnetic resonance imaging and amongthem 17 patients having vertebral artery dissection wereselected and magnetic resonance imaging findings werestudied using spin echo, diffusion weighted imaging and 3Dtime of flight MR angiography sequences.Results: Of the total 17 patients imaged with age range of23-59 years (mean age 38 years), 11 were males and 6 werefemales. V3 was the commonest site of dissection (n=10)followed by V4 (n=4) and V2 (n=3). The most commonpattern of dissection was steno-occlusive (n=15), whereas2 patients had aneurysmal type of dissection. T1W imagesrevealed intra-arterial thrombus in all the 17 patients. T2Wrevealed absent flow in vertebral artery in 5 patients. 3D TOFMRA revealed narrowed lumen in 10 patients and completeocclusion in 5 patients. One patient revealed intimal flap on3D TOF MRA.Conclusion: MRI is an excellent non-invasive modality forevaluation of posterior circulation stroke. MRI in conjunctionwith MR angiography helps clinch the diagnosis of VAD andthus helps in planning management and subsequent follow upof these patients.

Article | IMSEAR | ID: sea-198469


We report here a unique vascular pattern of left sided aortic arch, detected incidentally in a 55 year old female,who underwent CECT chest for symptom of chronic cough. There were five vessels arising from the convex aspectof the arch with sequence as right common carotid artery (RCCA), left common carotid artery (LCCA), left vertebralartery (LVA), left subclavian artery (LSA) and aberrant right subclavian artery (ARSA).