Magnetic resonance angiography and transcranial Doppler ultrasound findings in patients with a clinical diagnosis of vertebrobasilar insufficiency

OBJECTIVE: To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). METHOD: From our outpatient neurotology clinic, we selected patients (using the criteria proposed by Grad and Baloh) with a clinical diagnosis of VBI. We excluded patients with any definite cause for vestibular symptoms, a noncontrolled metabolic disease or any contraindication to MRA or TCD. The patients in the study group were sex- and age-matched with subjects who did not have vestibular symptoms (control group). Our final group of patients included 24 patients (study, n=12; control, n=12). RESULTS: The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. CONCLUSION: MRA failed to reveal abnormalities in patients with a clinical diagnosis of VBI compared with controls. The PI of the basilar artery, measured using TCD, demonstrated high sensitivity (91%) and specificity (91%) for detecting clinically diagnosed VBI.

Terapia endovascular de la trombosis de arteria basilar: reporte de 2 casos / Endovascular therapy of basilar artery thrombosis: 2 case report

Resumen Los eventos cerebrovasculares afectan el territorio de la circulación posterior pueden tener un comportamiento benigno,sin embargo, la oclusión de la arteria basilar suele tener consecuencias devastadoras. El uso de trombolísis sistémica ointra-arterial y la terapia endovascular son opciones terapéuticas con recuperación funcional apropiada. Se reportan doscasos de trombosis arterial basilar cuyo diagnóstico temprano permitió un manejo combinado entre embolectomía endovasculary trombólisis con resultados adecuados.

Abstract Stroke of the posterior cerebral circulation may have a benign course but basilar artery thrombosis usually have devastating consequences. Systemic thrombolysis and endovascular treatment are promising options with appropriate functional outcomes. We report two cases of basilar artery thrombosis in which early diagnosis and treatment with endovascular embolectomy and thrombolysis showed good results.

Relationship of inter-arm systolic blood pressure difference with subclavian artery stenosis and vertebral artery stenosis in patients undergoing carotid endarterectomy

Abstract Introduction: The aim of this study was to examine the association of inter-arm systolic blood pressure difference (IASBPD) with carotid artery stenosis, subclavian artery stenosis and vertebral artery stenosis in patients who underwent carotid endarterectomy. Methods: A total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD ˂ 10 mmHg, ≥ 10 mm Hg, ≥ 20 mmHg and ≥ 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as ≥ 50%. Results: Of the 141 patients, 44 (31.2%) had ≥ 10 mmHg, 29 (20.5%) had ≥ 20 mmHg and 4 (2.8%) had ≥ 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD ≥ 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis (P=0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis (P=0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis (P=0.01). Conclusion: Patients who were diagnosed with both subclavian artery stenosis and IASBPD (≥ 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic.

Cerebrovascular Drug-Eluting Stent versus Bare-Metal Stent in the Treatment of Vertebral Artery Stenosis: A Non-Inferiority Randomized Clinical Trial / 대한뇌졸중학회지

No abstract available.

Huge Vertebrobasilar Dolichoectasia

No abstract available.

Lower Cranial Nerve Palsy Due to Vertebrobasilar Dolichoectasia

No abstract available.

Manejo endovascular de estenosis vertebral intracraneal con stent coronario balón expandible: reporte de dos casos y revisión de la literatura / Endovascular management of intracranial vertebral stenosis with a coronary balloon-expandable-stent: report of two cases and literature review

RESUMEN INTRODUCCIÓN: El manejo endovascular de la estenosis de la arteria vertebral en pacientes con infarto cerebral recurrente continúa siendo un tema con múltiples lagunas de conocimiento debido a la poca evidencia científica con la que se cuenta en la actualidad. CASOS CLÍNICOS: Se informan dos casos típicos de estenosis vertebral y recurrencia de infarto cerebral cerebral manejados con dispositivos endovasculares alternativos a los utilizados en la actualidad (stent balón expandible medicado con zotarolimus), con desenlaces clínicos e imagenológicos satisfactorios. Se describe la técnica usada, la condición clínica y se ilustran los resultados angiográficos. CONCLUSIÓN: A la luz de las nuevas generaciones de dispositivos y técnicas neuroendovasculares, consideramos que debe realizarse una evaluación cuidadosa e individual de los pacientes con recurrencia de enfermedad cerebrovascular y estenosis vertebral, a pesar de un manejo médico optimizado. Aún se requieren estudios conrolados que permitan la uniformidad futura en la selección de pacientes y la toma de decisiones.

SUMMARY INTRODUCTION: Endovascular management of vertebral artery stenosis in patients with recurrent cerebral infarction remains a topic with multiple gaps in knowledge because of poor scientific evidence is available today. REPORT OF CASES: Here are reported two typical cases of cerebral infarction recurrence due to vertebral artery stenosis managed with new endovascular devices (balloon-expandable-stent medicated with zotaroli-mus), with satisfactory clinical and neuroimaging outcomes. Herein it is described the technique used and the angiographic findings are illustrated. CONCLUSION: In light of new devices and neurointerventional techniques, we consider that it should be done a careful and individual evaluation of patients with vertebral stenosis and stroke recurrence despite an optimized medical management. It is still required more studies that allow future consistency in the selection of patients and decision making.

Subclavian artery stenosis combined with vertebral artery stenosis may lead to compensatory blood flow changes in the contralateral vertebral artery / 南方医科大学学报

OBJECTIVE@#To investigate the severity of blood steal and the hemodynamic profiles in patients with subclavian artery stenosis combined with vertebral artery stenosis.@*METHODS@#A retrospective analysis was performed of transcranial Doppler (TCD) data from patients with subclavian artery stenosis (SAS) and concomitant unilateral/bilateral vertebral artery stenosis (VAS, >50%) or occlusion in our institution between February, 2014 and July, 2018.Thirty-seven patients with SAS combined with VAS (SAS+VAS) were reviewed for types of blood steal, peak systolic velocities of blood flow in affected subclavian artery and the contralateral vertebral artery, and the findings of hyperemia testing.These data were also reviewed for 39 SAS patients without VAS (control group) for comparison of blood steal and hemodynamic profiles.@*RESULTS@#In SAS+VAS group, 5 patients showed no blood steal; blood steal in stage Ⅰ was found in 22 patients, stage Ⅱ in 7, and stage Ⅲ in 3, as compared to the numbers of 17, 12 and 10 in the control group, respectively (H=9.431, =0.002).The peak systolic velocity of the contralateral vertebral artery was 43.91±17.43 cm/s in SAS+VAS group, significantly lower than that in the control group (53.56±17.45 cm/s; = 629.5, =0.006).Hyperemia testing showed a significant difference in the negative rate between SAS+VAS group and the control group[35.1%(13/37) 7.7%(3/39);=8.603, =0.003).@*CONCLUSIONS@#SAS combined with VAS may lead to reduced compensatory blood flow in the contralateral vertebral artery to lessen the severity of subclavian steal syndrome.

Symptomatic Bilateral Carotid Artery Occlusion: An Uncommon Pattern of Carotid Pathology

We report an unusual case of an 83-year-old man who was admitted with dizziness and repeated drop attacks. He was diagnosed with bilateral carotid artery occlusion and he underwent a left subclavian to left carotid bypass with ringed polytetrafluoroethylene graft. The patient's postoperative course was uneventful and no symptoms presented during a 6-month follow-up. Finally, we discuss on proper management of such patients.

Clinical Significance of Perverted Head-Shaking Nystagmus / 대한평형의학회지

OBJECTIVES: We investigated clinical significance of head shaking nystagmus (HSN) and perverted HSN (pHSN) in patients with peripheral and central vestibular disorders. METHODS: We reviewed medical records of 822 consecutive subjects who were referred to a dizziness clinic. We performed neurologic examination including video-oculography in darkness for 60 seconds before, during and for 100 seconds after head-shaking. HSN was considered to develop when post-head-shaking nystagmus last at least 5 beats with latency from end of head-shaking of no more than 5 seconds, and a velocity at least 3°/sec. RESULTS: In control group (n=45), there were observed spontaneous nystagmus (SN) in 2.2%, HSN in 17.8%, pHSN in 6.7%. In patients with peripheral vestibular disorder group (n=397), there were observed SN in 14.1%, HSN in 40.6%, pHSN in 9.8%. In patients with central vestibular disorder group (n=217), there were observed SN in 17.5%, HSN in 24.0%, pHSN in 13.4%. In unspecified dizziness group (n=208), there were observed SN in 1.9%, HSN in 13.0%, pHSN in 1.9%. pHSN was frequently observed in central vestibular disorders such as stroke, vestibular migraine, cerebellar ataxia, and vertebro-basilar insufficiency. However, pHSN was also observed at higher rate than expected in peripheral vestibular disorders including benign paroxysmal positional vertigo especially involving vertical canals, Meniere disease and even in unilateral vestibulopathy. CONCLUSIONS: Our results show that perverted HSN in dizzy populations was frequently observed not only in cases of central vestibular disorders but also in peripheral disorders. Perverted HSN can develop by any conditions that cause difference in vestibular velocity storage in vertical component of vestibular-ocular reflex.

Overview of new progresses in neurointervention: promise and problems / 中华外科杂志

In recent two years, new reports about concepts, technologies, materials, and especially new clinical trial results for endovascular treatment of cerebrovascular diseases, has provided tremendous promise for further progress. Mechanical thrombectomy becomes a guideline-recommended therapy for acute ischemic stroke patients with large vessel occlusion, which is considered as a landmark event. The superiority of endovascular coiling over neurosurgical clipping has been further proved for intracranial aneurysm. New devices are constantly developing for aneurysm occlusion. For brain arteriovenous malformation, application of detachable-tip microcatheters improves safety of embolization procedure, and successful transvenous embolization has been also achieved in a few cases. Long-term result of carotid stenting for symptomatic patients has been proved to be noninferior to carotid endarterectomy. Meanwhile, some new trials only obtain negative results, for example, endovascular stenting for intracranial or vertebral artery stenosis both show worse outcomes compared with medical therapy alone. More advancements and investigations are needed.

A Case of Acute Inner Ear Dysfunction as a Prodrome of Transient Ischemic Attack Caused by Vertebral Artery Stenosis / 대한이비인후과학회지

A sudden hearing loss with vertigo may originate from vascular insufficiency and sometimes presents as an initial manifestation of posterior brain circulation infarction. However, it is unusual that sudden hearing loss and vertigo present as a prodrome of transient ischemic attack. Here we describe the case of a 54-year-old male patient with hypertension who presented with a sudden onset of hearing loss in his right ear and recurrent severe, whirling type dizziness without associated neurological signs or symptoms. The diffusion-weighted magnetic resonance imaging (MRI) was normal on initial presentation. Ten days later, however, the patient developed dysarthria. A follow-up MRI including the diffusion-weighted images was normal but cerebral angiography showed severe narrowing of right vertebral artery. Transient ischemic attack caused by vertebrobasilar artery stenosis should be considered in sudden hearing loss and vertigo, especially patients with vascular risk factors, even though images of brain MRI are normal.

A Case of Dolichoectasia of Vertebrobasilar Artery Presenting Simultaneous Bilateral Sudden Sensorineural Hearing Loss with Vertigo / 대한평형의학회지

Sudden sensorineural hearing loss (SNHL) develops usually in unilateral ear without known etiology. In contrast, bilateral sudden SNHL is mostly related to serious systemic diseases and have a severe hearing loss and poor prognosis compared than unilateral one. We describe here a 59-year-old man presented with a bilateral sudden SNHL and vertigo possibly attributed to dolichoectasia in vertebrobasilar artery, and discuss the possible mechanism.

Síndrome de enclaustramiento: presentación de un caso / Locked-in syndrome: case report

El síndrome de enclaustramiento (Locked-in syndrome) es una entidad neurológica altamente discapacitante, producida por lesiones en la porción ventral de la protuberancia; de etiología principalmente vascular. Clínicamente se manifiesta por tetraplejía, anartria, preservación de la conciencia y capacidad de expresarse mediante movimientos oculares. Presentamos el caso de un paciente masculino de 33 años, transferido de otra institución de salud con un cuadro clínico progresivo y poco específico, caracterizado principalmente por deterioro del estado de conciencia, dificultad respiratoria, cefalea de intensidad moderada y vómitos. Mediante pruebas de imágenes se comprobó la presencia de un área de isquemia en la región irrigada por el sistema vertebrobasilar. Se realizó un enfoque diagnóstico y terapéutico invasivo de orden endovascular.

Locked-in syndrome is a highly disabling neurological entity, due to lesions in the ventral portion of the pons, mainly vascular etiology. Clinical features are quiadriplegia, anarthria, preservation of consciousness and the ability to express by ocular movements. We shown a case of a 33 years-old man, who was transfer from another institution with a progressive and poorly specific clinical manifestations, mainly characterized by diminishing of consciousness, breathing difficulty, headache and vomiting, with the presumptive diagnosis of central nervous system infection. We performed image diagnostic tests and they shown and ischemic feature in the region of the vertebrobasilar irrigation. It was perform an endovascular diagnostic therapeutic approach.

Efectos de las maniobras cervicales en el flujo arterial vertebral extracraneal en pacientes con insuficiencia vertebrobasilar / Effects of the cervical maneuvers in the vertebral extracraneal arterial flow in patients with vertebrobasilar failure

Se realizó un estudio cuasiexperimental de 52 pacientes con insuficiencia vertebrobasilar, atendidos en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde septiembre hasta marzo del 2014, a fin de determinar los efectos de las maniobras de rotación cervical en el flujo sanguíneo a nivel de las arterias vertebrales extracraneales. Entre las variables analizadas figuraron: edad, sexo, maniobra de rotación cervical y velocidad diastólica final. Se emplearon la media y las proporciones como medidas de resumen, así como la prueba estadística de Ji al cuadrado de Friedman, con un nivel de significación de 0,05. Predominaron los afectados de 45-54 años en ambos sexos. Las maniobras de rotación cervical condujeron a una disminución en la velocidad diastólica final de las arterias vertebrales y redujeron el flujo sanguíneo arterial vertebral extracraneal.

A quasi-experimental study of 52 patients with vertebrobasilar failure, assisted in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from September to March, 2014, in order to determine the effects of the cervical rotation maneuvers in the blood flow at the level of the extracraneal vertebral arteries. Among the analyzed variables there were: age, sex, maneuver of cervical rotation and final diastolic speed. The mean and proportions were used as summary measures, as well as the Friedman statistical Chi squared test, with a significance level of 0,05. The 45-54 years affected patients prevailed in both sexes. The cervical rotation maneuvers led to a decrease in the final diastolic speed of the vertebral arteries and reduced the extracraneal vertebral arterial blood flow.

Stenting for Symptomatic Vertebral Artery Stenosis Associated with Bilateral Carotid Rete Mirabile: The Long-Term Clinical and Angiographic Outcome

Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rete mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.

Vertebrobasilar insufficiency caused by cervical aneurysmal bone cyst - case report / Insuficiência vertebrobasilar causada por cisto ósseo aneurismático cervical - relato de caso

Aneurysmal bone cysts (ABC) are benign bone tumors of relatively rare occurrence. Most of the lesions occur at long bones, vertebrae and flat bones. However, the cervical vertebrae involvement is uncommon. Occasionally, the ABCs compress the spinal cord and nerve roots. Depending on the level of involvement and the extent of spinal cord compression, a wide variety of neurological symptoms and signs may be noted later, ranging from mild radiculopathy to complete paraplegia or tetraplegia. A case of aneurysmal bone cyst involving the second and third cervical vertebrae in a 15 years old patient, causing compression of the right vertebral artery and subsequent vertebrobasilar insufficiency is reported. We also discuss the clinical manifestations of the vertebrobasilar insufficiency, of the spinal compression, and the surgery treatment performed in this case.

Cistos ósseos aneurismáticos são tumores ósseos benignos de ocorrência relativamente rara. A maior parte dessas lesões ocorre em ossos longos, nas vértebras e nos ossos planos. No entanto, o envolvimento das vértebras cervicais é incomum. Ocasionalmente, o cisto ósseo aneurismático pode comprimir a medula espinhal e as raízes nervosas. Dependendo do grau de envolvimento e extensão da compressão da medula espinhal, uma ampla variedade de sintomas e sinais neurológicos pode ser observada posteriormente, variando de radiculopatia suave a completa paraplegia ou tetraplegia. Relatamos um caso de cisto ósseo aneurismático envolvendo a segunda e a terceira vértebra cervical em um paciente de 15 anos, causando compressão da artéria vertebral direita e consequente insuficiência vertebrobasilar. Também discutimos as manifestações clínicas da insuficiência vertebrobasilar e da compressão espinhal e o tratamento cirúrgico realizado no caso em questão.

Clinical efficacy on vertebrobasilar insufficiency treated with auricular acupuncture / 中国针灸

<p><b>OBJECTIVE</b>To compare the efficacy on vertebrobasilar insufficiency (VBI) between auricular acupuncture therapy and oral administration of medicine.</p><p><b>METHODS</b>Sixty patients of VBI were randomized into an auricular acupuncture therapy group and a medicine group, 30 cases in each one. In the auricular acupuncture group, acupuncture was applied bilaterally to gan (CO12) and jiejie (HX8) on the ears and needles were retained for 15 min. After needle withdrawal, the vaccariae semen were fixed with plaster at naogan (AT3, 4i), zhen (AT3), jing (AH12), shen (CO10) and pi (CO13) on the ears. In the medicine group, flunarizine hydrochloride capsules (Sibelium), 5mg were prescribed for oral administration, once every night. The treatment lasted continuously for 2 weeks (14 days) in the two groups. In 2 weeks, the clinical efficacy was assessed and the transcranial doppler (TCD) examination was performed.</p><p><b>RESULTS</b>After treatment, the symptom scores were all apparently reduced in the patients of the two groups (P < 0.01, P < 0.05). Compared with the medicine group, the reduced score was much more obvious in the auricular acupuncture group (P < 0.05), indicating the significant difference. After treatment, with TCD examination, the blood velocity was increased to different degrees in the patients of low velocity type in the auricular acupuncture group and the medicine group; that was reduced to different degrees in the patients of high velocity type in the auricular acupuncture group and the medicine group. All of them were different significantly as compared with those before treatment (all P < 0.05). But the difference was not significant between the two groups (both P > 0.05). In comparison of clinical efficacy between the two groups, the effective rate was 93.3% (28/30) in the acupuncture group and better than 76.7% (23/30) in the medicine group, indicating the significant difference in comparison (P < 0.05).</p><p><b>CONCLUSION</b>The auricular acupuncture therapy achieves the definite efficacy on VBI and the efficacy is better than flunarizine hydrochloride capsules.</p>

A rare case of vertebrobasilar dolichoectasia presenting with ipsilateral facial paresis and concomitant severe sensorineural hearing loss

@#p style=text-align: left;strongOBJECTIVE:/strong To report a case of vertebrobasilar dolichoectasia presenting with ipsilateral facial nerve paresis and concomitant severe sensorineural hearing loss.METHODS/strong:br /strongDesign:/strong Case Reportbr /strongSetting:/strong Secondary Government Hospitalbr /strongPatient:/strong One RESULTS:/strong We report a case of vertebrobasilar dolichoectasia with concomitant ipsilateral facial nerve paresis and severe sensorineural hearing loss in an elderly female. She presented to us with left facial nerve palsy House-Brackmann Grade III and prior history of ipsilateral sensorineural hearing loss. MRI of the brain showed normal inner ear structures but revealed a dilated and tortuous basilar artery with compression on the left medulla and possible branches of anterior inferior cerebellar artery as it coursed superiorly and possible partial thrombosis of proximal basilar artery.CONCLUSION:/strong Concomitant facial nerve paresis and sensorineural hearing loss can be the clinical presentations of this rare but important condition. MRI is vital in diagnosing vertebrobasilar dolichoectasia./p