OBJECTIVE AND IMPORTANCE: Dissecting aneurysms of the intracranial vertebral artery are increasingly recognized as a cause of subarachnoid hemorrhage. We present a case involving technical success of the stent-supported coil embolization but with recurrence of the dissecting pseudoaneurysm of the intracranial vertebral artery. The implications for the endovascular management of ...

Hemimedullary infarction, which presents Babinski-Nageotte syndrome, has been mainly reported to result from atherosclerotic occlusion of the vertebral artery. A 54-year-old housewife with right nuchal pain developed Wallenberg's syndrome followed by left hemiparesis. Diffusion-weighted magnetic resonance imaging documented fresh infarcts in the right hemimedulla and right dorsal cerebellum. Angiography revealed ...

A 50-year-old man presented with subarachnoid hemorrhage from a ruptured cerebral aneurysm arising from a left posterior inferior cerebellar artery (PICA)-anterior inferior cerebellar artery anastomotic artery manifesting as severe headache, obtundation, and quadriplegia. Conventional and three-dimensional digital subtraction angiography showed that the anastomotic complex was present bilaterally and both vertebral ...

The aim of this study was to present the anatomic and macroscopic aspects of the vertebral artery at the level of the dural crossing. Twenty vertebral arteries in 10 cadavers were dissected. The preparations were photographed and all the samples at the level of the dural crossing were submitted to ...

BACKGROUND: Lesion topography and the pathophysiological background of dysarthria due to focal cerebellar lesions have not yet been fully clarified. OBJECTIVES: To investigate the lesion topography of dysarthria due to cerebellar ischemia and evaluate brainstem functions. DESIGN: Case studies. PATIENTS: Eighteen right-handed patients with sudden-onset dysarthria and cerebellar ischemia with ...

Atherosclerotic lesions are very common at the origin and first few centimeters of the vertebral artery in the neck. These lesions are often missed when using noninvasive diagnostic strategies. These lesions cause transient hypoperfusion and transient ischemic attacks, characterized mostly by vestibulocerebellar symptoms. Strokes are caused by embolism from these ...

OBJECTIVE AND IMPORTANCE: Cervical myelopathy induced by vascular compression is rare. We report a case caused by bilateral persistence of the first intersegmental arteries (a vertebral artery anomaly). Myelopathy was successfully treated with vascular decompression. CLINICAL PRESENTATION: A 66-year-old woman presented with gradually worsening paroxysmal neck and arm pain. Magnetic ...

The case is presented of a 19-year-old man who was assaulted and died shortly afterward from a large traumatic basal subarachnoid hemorrhage (TBSAH) that arose from rupture of the left vertebral artery, proximal to the point at which the artery penetrated the dura. The literature regarding TBSAH and vertebral artery ...

With the improvement of medical imaging and surgical techniques, surgery on cervical vertebral is more frequent. Some cases of complications of this type of surgery have been described. We report a case of postoperative bilateral vertebral artery dissection. It concerns a 58 year-old woman who suffered from a left cervico-brachial ...

A 42-year-old woman presented with a ruptured aneurysm of the distal posterior inferior cerebellar artery (PICA), which had a rare extracranial and extradural origin. Medial suboccipital craniectomy and C-1 laminectomy were performed. The aneurysm had adhered to the right cerebellar tonsil, but was successfully clipped without difficulty. Intraoperatively, the PICA ...

Anomalies of the vertebral arteries are uncommon, but important to recognize in the diagnosis and catheter based evaluation and treatment of patients suffering cerebrovascular disease. This article illustrates our experience with such anomalies. These include the vertebral artery arising as the fourth and most distal branch of the aortic arch, ...

A 63-year-old hypertensive man presented with vertebral artery (VA) dissection manifesting as subarachnoid hemorrhage located mainly in the posterior fossa. Left vertebral angiography on the day of hemorrhage showed complete occlusion of the left VA. Right vertebral angiography showed retrograde filling of the distal portion of the left VA and ...

STUDY DESIGN: Patients with cervicobrachial pain were examined in detail with special attention to vertebral artery loop formation. OBJECTIVES: To determine the incidence, short-time natural course and response to a conservative approach to vertebral artery loop formation in a group of patients with cervicobrachial pain. SUMMARY OF THE BACKGROUND DATA: ...

PURPOSE: To illustrate the utility of color flow duplex ultrasound (CFDU) in the diagnosis and stent-graft treatment of a rare arteriovenous fistula (AVF) involving the vertebral artery and vein. CASE REPORT: An iatrogenic AVF involving the right vertebral artery and vein was diagnosed in a 45-year-old man using CFDU. Treatment ...

We describe the usefulness of transesophageal echocardiography in correctly diagnosing severe ostial stenosis of both the left and right vertebral arteries in an adult patient. Although transesophageal echocardiography has been previously used to identify left vertebral artery stenosis, to our knowledge this study represents the first demonstration of its usefulness ...

BACKGROUND: Cases of lesions to either the carotid artery or the vertebral artery in anterior approaches to the cervical spine are rarely found in medical literature. Two cases of vertebral artery injury in anterior approaches as well as a review of the pertinent literature are presented. In cases of arterial ...

STUDY DESIGN: The feasibility of inserting a screw for the narrow isthmus with a high-riding vertebral artery was evaluated in patients subjected to posterior atlantoaxial transarticular screw fixation. OBJECTIVE: To demonstrate the feasibility of inserting bilateral screws and obtaining a stable atlantoaxial complex for patients with a high-riding vertebral artery. ...

A 50-year-old male was hit by a high-speed golf ball on the left lateral side of his neck. He collapsed immediately and was sent to hospital, where he was pronounced dead. The autopsy showed an extensive basal subarachnoid haemorrhage. Careful gross and histological examinations disclosed a rupture of the right ...

After an episode of vasodilator-induced systemic hypotension, a 75-year-old man developed ocular lateropulsion to the right, left-side-dominant quadriparesis, loss of superficial sensation below C4 dermatome level, and anuresis. Magnetic resonance imaging (MRI) showed infarcts in the right cerebellar hemisphere (posterior inferior cerebellar artery territory) and the upper cervical cord (anterior ...

A 21-year-old male presented with sudden onset of right-sided third nerve paresis. Angiogram showed a fenestrated posterior communication artery on the right side and no other vascular anomalies. There was no other lesion that could suggest a cause for the third nerve weakness. Fenestration of the posterior communicating artery has ...

Vertebral arteriovenous fistulas are rare in children and the congenital form has been seldom reported in the literature. Prior to using endovascular therapy techniques, only surgery was the main treatment. The most common endovascular treatment is through the use of detachable balloons. This report describes the clinical and radiological findings ...

PURPOSE: To describe successful endovascular repair of a recurrent vertebral arteriovenous fistula (AVF) after surgical correction. CASE REPORT: A 42-year-old woman presented with recurrent dizziness, nausea, and headaches. A loud bruit in the right neck was present. Central venous catheter insertion had been done 1 year previously, creating an angiographically ...

The extracranial segment of the vertebral artery is well protected, and the rate of occurrence of extracranial vertebral aneurysms is very low. We describe the case of a 40-year-old woman who presented with a large aneurysm of the left vertebral artery in the angiographic absence of a right vertebral artery. ...

Case report of a complete arcuate foramen in a human atlas vertebra inhibiting the placement of lateral mass screw instrumentation at C1. Our objective is to report the presentation of the case, the operative considerations, and the management for this anatomic variation. The groove for the vertebral artery on the ...

We report a case of isolated traumatic pseudoaneurysm of the vertebral artery in a 20-year-old man who suffered blunt injury to the left foreneck and arm in a traffic accident. A chest computed tomography (CT) scan on admission showed an upper mediastinal hematoma, but the patient's vital signs were stable. ...

A 51-year-old female with a ruptured dissecting vertebral artery aneurysm underwent an uneventful wrapping technique using Biobond-soaked gauze through a unilateral suboccipital transcondyle approach. On the 3rd postoperative day, she developed pareses of the ipsilateral VII through XII cranial nerves. Daily intravenous administration of 300 mg of hydrocortisone was started. ...

Of the many causes of vertebrobasilar insufficiency (VBI), extrinsic compression of the vertebral artery (VA) is relatively uncommon. A syndrome of VBI caused by extrinsic compression of the VA secondary to head rotation has been termed positional vertebrobasilar ischemia. The authors present a case of transient VBI caused by herniation ...

This study reports an anatomical study of the vascular supply in 20 Akkaraman sheep cerebelli from adult subjects of both sexes. The origin and branching pattern of the cerebellar artery vascularising the cerebellar nuclei were studied by gross dissection and vascular injection. Then dissection was performed and vessels nourishing the ...

A 51-year-old man presented with loss of consciousness when he underwent urological examination at another hospital. CT scans showed subarachnoid hemorrhage, and cerebral angiography showed bilateral dissecting aneurysms of the vertebral arteries. Following ventricular drainage, the lesion was managed conservatively with blood pressure control but again ruptured on day 8. ...

Vertebral artery (VA) occlusion by rotation of the head is uncommon, but can result from mechanical compression of the artery, trauma, or atlantoaxial instability. Occipital bone anomalies rarely cause rotational VA occlusion, and patients with nontraumatic intermittent occlusion of the VA usually present with compromised vertebrobasilar flow. A 34-year-old man ...

STUDY DESIGN: Technical note. OBJECTIVE: To describe a technique for performing percutaneous vertebroplasty of C1 for treatment of osteolytic metastatic disease involving the lateral portions of the atlas in which precautions are taken to protect the vertebrobasilar arterial supply and a posterior access route is used for cement delivery. SUMMARY ...

A 49-year-old man presented with nontraumatic bilateral intracranial vertebral artery dissections without subarachnoid hemorrhage manifesting as Wallenberg's syndrome on the right. Magnetic resonance imaging revealed an infarct in the right dorsolateral aspect of the medulla oblongata. Antiplatelet therapy was administered. Vertebral angiography performed on the 9th hospital day (Day 9) ...

OBJECTIVE: To describe a case of dissection of the postero-inferior cerebellar artery (PICA) after cervical manipulation. Clinical Features: After cervical manipulation, a 42-year-old woman had a cerebellar syndrome related to an infarct in the area supplied by the PICA, confirmed by computed tomography of the brain. Cerebral angiography showed a ...

OBJECTIVE: It has been proposed that Doppler velocimetry, which is noninvasive, quick, and relatively inexpensive, should be used when the screening vertebral arteries before manipulation to reduce the risk of cervical manipulation-related injury to these vessels. The objective of this analysis of the literature is to study the evidence of ...

Large parapharyngeal space tumors near critical neurovascular structures pose challenging management problems. Only eight cases of a lipoma in the parapharyngeal space have been reported. We present a surgical approach that permits safe resection of such unusual tumors.A 49-year-old man had a 2-year history of progressive pain in the left ...

Endovascular management of supra-aortic atherosclerotic vascular disease is becoming relatively common in the innominate, subclavian, and carotid arteries. However, revascularization of vertebral artery disease is an infrequently used treatment option due to several reasons: 1) stroke etiology and prevention is generally considered with respect to carotid disease as posterior circulation ...

We report the development of a new MRI technique which allows spins from right-sided arteries to be labeled separately from spins from left-sided arteries. This method uses two spatially-selective adiabatic inversion pulses to alternate the labeling of the right carotid and vertebral artery separate from the left carotid and vertebral ...

Summary: A new Xpeedior rheolytic thrombectomy catheter has been successfully used to extract thrombus from an acutely thrombosed vertebral artery stent without apparent distal embolism. The ease of use and the speed of thrombectomy suggest that this system may be useful for the treatment of acute ischemic stroke.

To date, vertebral venous valves have not been studied clinically or by sonography. This report reveals that these valves could be studied noninvasively by using sonographic techniques. Real-time sonography clearly showed the opening and closing of the two cusps of vertebral venous valves at the junction of the vertebral vein ...

We present a 49-year-old man with a subarachnoid haemorrhage from a dissecting vertebral artery (VA) pseudoaneurysm treated with a proximal balloon occlusion. The clinical course was complicated by the sudden appearance of a lateral medullary syndrome (Wallenberg), which completely resolved after anticoagulant therapy. During this course, CT-angiography (CTA) enabled monitoring ...

The most prevalent lesion of the vertebral artery is an atheromatous plaque located at its origin from the subclavian artery. A case of successful management of a symptomatic vertebral artery aneurysm due to Ehlers-Danlos syndrome is reported. The patient had asymptomatic posterior intracerebral artery dissection on the contralateral side. A ...

BACKGROUND AND PURPOSE: We report a case of sudden onset pharyngeal pain due to dissection of the vertebral artery. CASE DESCRIPTION: A 65-year-old patient presented with sudden onset of unilateral pharyngeal pain, which was first, diagnosed as idiopathic glossopharyngeal neuralgia. Magnetic resonance image and cerebral angiography revealed a dissecting vertebral ...

Focal signal intensity loss of the basilar artery on MR angiograms obtained in a 69-year-old man was considered to be caused by an embolus, and thrombolytic therapy was initiated. On the follow-up MR angiograms, the same oval signal intensity loss of the basilar artery was observed. On the basis of ...

The objective of this study was to determine the level of the aortic bifurcation in relation to the lumbar spine by MRI and the effect of lumbosacral anomalies on the aortic bifurcation. A prospective study of 441 patients was performed. Sagittal MR images of the entire spine were obtained along ...

OBJECTIVE: To determine whether lumen narrowing in vertebral arteries during atlanto-axial rotation is due to stretch or localized compression. DESIGN AND SETTING: Experiments with models were made in a private chiropractic clinic, whereas studies of cadaveric specimens were performed in an anatomy laboratory. Doppler ultrasound and magnetic resonance angiography (MRA) ...

We present seven children with atlantoaxial rotatory fixation (AARF) of more than three months' duration after an injury to the upper cervical spine. The deformity was irreducible by skull traction. MRI and MR angiography (MRA) of the vertebral arteries were performed in four children. The patients were neurologically intact. Thrombosis ...

A 22-year-old woman sustained a stab wound injury of the right vertebral artery. Initial treatment with endovascular embolization using platinum coils in a local hospital could not stop the bleeding. The patient was transferred to our department in hypovolemic shock. Further angiography revealed an arteriovenous fistula. Open surgical revision occluded ...

PURPOSE: The aim of this study was to determine the resistance index (RI) in the fetus in both the vertebral artery and the internal carotid artery and to evaluate the relationship of those RIs with that of the umbilical artery. METHODS: In this prospective study, color Doppler examinations of the ...

Vertebral arteriovenous fistulas are rare lesions consisting of an abnormal shunt between the extracranial vertebral artery and the neighboring veins. The authors present a case of post-surgical high-flow left vertebral arteriovenous fistula presenting with intracranial hemorrhage. The patient underwent endovascular balloon occlusion of the fistula: after endovascular treatment a reduction ...

OBJECT: In patients with aneurysms that require occlusion of the posterior inferior cerebellar artery (PICA), revascularization of this artery should be performed. A novel surgical method for revascularization of the PICA is presented. METHODS: After a segment of the superficial temporal artery (STA) was harvested, the aneurysm was treated by ...