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Vertebrobasilar insufficiency

Vivek P Buch, Peter J Madsen, Kerry A Vaughan, Paul F Koch, David K Kung, Ali K Ozturk
Rotational vertebrobasilar insufficiency, or bow hunter's syndrome, is a rare cause of posterior circulation ischemia, which, following rotation of the head, results in episodic vertigo, dizziness, nystagmus, or syncope. While typically caused by dynamic occlusion of the vertebral artery in its V2 and V3 segments, the authors here describe a patient with dynamic occlusion of the vertebral artery secondary to a persistent first intersegmental artery, a rare variant course of the vertebral artery. In this case the vertebral artery coursed under rather than over the posterior arch of the C-1...
October 7, 2016: Journal of Neurosurgery. Spine
Guangxin Duan, Jiaping Xu, Jijun Shi, Yongjun Cao
Bow hunter's syndrome (BHS), also known as rotational vertebral artery (VA) occlusion syndrome, is a rare yet treatable type of symptomatic vertebrobasilar insufficiency resulting from mechanical occlusion or stenosis of the VA during head and neck rotation or extension. The symptoms of BHS range from transient vertigo to posterior circulation stroke. The underlying pathology is dynamic stenosis or compression of the VA by abnormal bony structures with neck rotation or extension in many cases, such as osteophyte, disc herniation, cervical spondylosis, tendinous bands or tumors...
June 2016: Interventional Neurology
Daniel R Felbaum, Joshua E Ryan, Andrew B Stemer, Amjad N Anaizi
Rotational vertebral artery occlusion (RVAO) or bow hunter's syndrome most commonly affects the C1-2 level due to its importance in regulating rotational movement. We present a 50-year old man who had undergone several prior sub-axial cervical spine operations with increasing neck pain and severe symptoms of vertebrobasilar insufficiency with bi-directional head rotation. Dynamic cerebral angiography demonstrated complete occlusion of left vertebral artery during head rotation to the right, and complete occlusion of the right vertebral artery during head rotation to the left...
September 5, 2016: World Neurosurgery
Leszek Wrotniak, Anna Kabłak-Ziembicka, Agnieszka Rosławiecka, Piotr Musiałek, Paweł Bogacki, Mariusz Trystuła, Krzysztof Żmudka, Tadeusz Przewłocki
OBJECTIVE: A minor part of patients with subclavian or innominate artery occlusive disease (subclavian artery stenosis [SAS]) experience symptoms of vertebrobasilar insufficiency, upper extremity exertional ischemia (UEEI), or cardiac ischemia owing to subclavian-coronary steal (SCS) in some instances. The study aimed to assess the impact of percutaneous transluminal angioplasty (PTA) of symptomatic SAS on symptom resolution and to determine factors related with SAS recurrence. METHODS: Symptom resolution and incidence of restenosis (RS) were evaluated for up to 15 years in patients who had undergone successful PTA of SAS...
September 2016: Journal of Vascular Surgery
M S Ulu, M Beker-Acay, S Ulu, E Unlu, A Bucak, G Yaman, A Altug, M S Tekin, S Oruc
OBJECTIVES: Vertebrobasilar insufficiency (VBI) is a pathology arising from the reduction in flow rate of vertebral arteries and mainly caused by inflammation and atherosclerosis. Gamma-glutamyltransferase (GGT) is a marker which has been recently recognized as a marker of inflammation and atherosclerosis. We aimed to investigate the relationship between GGT levels and VBI for the first time. METHODS: In this cross-sectional study, of 3100 subjects who had vertebrobasilar doppler ultrasonography (VBU) were evaluated and 1042 of them who met the inclusion criterias were included...
2016: Bratislavské Lekárske Listy
Murat Şakir Ekşi, Zafer Orkun Toktaş, Baran Yılmaz, Mustafa Kemal Demir, Emel Ece Özcan-Ekşi, Ahmed B Bayoumi, Yasin Yener, Akın Akakın, Deniz Konya
PURPOSE: Vertebral artery loop is a congenital or acquired anomaly. Vertebral artery loops are incidentally diagnosed during evaluation of neck problems and trauma. We aimed to present the incidence of VA loops using magnetic resonance angiography in consecutive patients and discuss epidemiological data including the gender, age, location, signs and symptoms, treatment approaches and outcomes of VA loops via analyzing literature. METHODS: In the first leg of our two-legged study, consecutive patients were evaluated using magnetic resonance angiography to detect any medial loop of vertebral arteries...
July 7, 2016: European Spine Journal
Bili Su, Yongjun Kan, Jianwei Xie, Juan Hu, Wensheng Pang
The complexity of traditional Chinese medicines (TCMs) is related to their multi-component system. TCM aqueous decoction is a common clinical oral formulation. Between molecules in solution, there exist intermolecular strong interactions to form chemical bonds or weak non-bonding interactions such as hydrogen bonds and Van der Waals forces, which hold molecules together to form "molecular aggregates". Taking the TCM Puerariae lobatae Radix (Gegen) as an example, we explored four Gegen decoctions of different concentration of 0...
2016: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
Yin-Hsuan Hsu, Hsiao-Yun Hu, Yu-Chwen Chiu, Fei-Peng Lee, Hung-Meng Huang
IMPORTANCE: Little is known about the association between sudden sensorineural hearing loss (SSNHL) and vertebrobasilar insufficiency (VBI). OBJECTIVE: To explore the association between SSNHL and VBI. DESIGN, SETTING, AND PARTICIPANTS: This investigation was a population-based, case-control study. Patients from January 1, 2000, to December 31, 2011, were retrospectively identified from the Taiwan National Health Insurance Research Database, which includes claims data on a random sample of 1 million people...
July 1, 2016: JAMA Otolaryngology—Head & Neck Surgery
Nauman S Chaudhry, Sudheer Ambekar, Mohamed Samy Elhammady, Jonathan P Riley, Gustavo Pradilla, Raul G Nogueira, Faiz U Ahmad
Rotational vertebral artery occlusion, also known as bow hunter's syndrome, is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. The authors sought to determine whether intraoperative indocyanine green (ICG) angiography could reliably assess the adequacy of surgical decompression of the vertebral artery (VA). The authors report two patients who presented with multiple transient episodes of syncope provoked by turning their head to the right...
August 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Salman Afsharpour, Kathryn T Hoiriis, R Bruce Fox, Samuel Demons
BACKGROUND: The objective of this paper is to describe the relationship of the vertebral artery (VA) to the Atlas (C1) in the sub-occipital region in the presence of arcuate foramen; and discuss the clinical implications related to manual therapies and surgical implications related to screw placement. This study is an anatomical cadaveric case report of symmetrical bilateral lateral and dorsal arcuate foramina on the C1 dorsal arch. CASE PRESENTATION: Out of 40 cadavers that were available for use in teaching anatomy in the university setting, three presented with anomalies of the C1 dorsal arch...
2016: Chiropractic & Manual Therapies
Emin Cakmakci, Safiye Tokgoz Ozal, Esra Karabay Ogutcu, Alper Aydin, Suzan Tunc, Umut Kaygusuz, Hasibe Gokce Cinar
BACKGROUND: The aim of the current study was to investigate whether signal intensities on magnetic resonance imaging (MRI) views and radiological findings on Doppler ultrasonography may have a diagnostic value for vertebrobasilar insufficiency (VBI). METHODS: This case-control study was performed on demographic and radiologic data derived from 18 VBI patients and 58 healthy controls in the radiology department of a tertiary care center. The blood flow characteristics including peak systolic and end diastolic flow rates, resistance and pulsatility indices, mean velocities, flow rates, diameters and intensity pattern of vertebral arteries on cervical and cranial MRI sequences were noted...
December 2015: Quantitative Imaging in Medicine and Surgery
Seong Mook Kim, Sung-Il Sohn, Jeong-Ho Hong, Hyuk-Won Chang, Chang-Young Lee, Chang-Hyun Kim
OBJECTIVE: Acute vertebrobasilar artery occlusion (AVBAO) is a devastating disease with a high mortality rate. One of the most important factors affecting favorable clinical outcome is early recanalization. Mechanical thrombectomy is an emerging treatment strategy for achieving a high recanalization rates. However, thrombectomy alone can be insufficient to complete recanalization, especially for acute stroke involving large artery atheromatous disease. The purpose of this study is to investigate the safety and efficacy of mechanical thrombectomy in AVBAO...
November 2015: Journal of Korean Neurosurgical Society
Hidehiro Takekawa, Keisuke Suzuki, Takahito Nishihira, Akio Iwasaki, Eisei Hoshiyama, Madoka Okamura, Ayaka Numao, Shiho Suzuki, Koichi Hirata
Bow hunter's stroke (BHS) is a rare cause of vertebrobasilar insufficiency due to rotational vertebral artery (VA) occlusion associated with head turning. We report a juvenile patient presenting with recurrent ischemic stroke caused by BHS, which was revealed by carotid duplex ultrasonography. Carotid duplex ultrasonography performed in the neutral position showed normal findings. However, disappearance of end-diastolic blood flow of contralateral VAs was observed with head rotation. Digital subtraction angiography confirmed occlusion at C1/2 levels in the VA contralateral to the head rotation, bilaterally...
July 2015: Journal of Medical Ultrasonics
Piotr Niewiadomski, Hanna Zielińska-Bliźniewskaw, Jarosław Miloński, Piotr Pietkiewicz, Jurek Olszewski
INTRODUCTION: The aim of this work was to evaluate the diagnostic value of the neck torsion test in VNG, Doppler ultrasonography and brainstem auditory evoked potentials in patients with vertigo and/or hearing loss due to intracranial vascular malformations. MATERIAL AND METHODS: The study covered 47 patients, 30 female and 17 male (mean age, 55.5 years; range, 19-74 years) with vertigo and/or hearing disorders and the asymmetry of vertebral arteries. Each patient underwent a subjective examination, an otolaryngological examination, otoneurological diagnostics, VNG with gaze tracking in the straight ahead position and in the 600 left and right neck torsion, the neck torsion test, audiological diagnostics including I-, III- and V-wave latency of the brainstem evoked potentials in the straight ahead position and the right ear stimulation in the 600 right neck torsion and the left ear stimulation in the neck torsion to the left, Doppler ultrasonography with measuring the diameter of vertebral arteries and the velocity of the blood flow in these vessels with the use of the neck torsion test...
2015: Otolaryngologia Polska. the Polish Otolaryngology
Sneha Konda, Samantha Dayawansa, Soren Singel, Jason H Huang
INTRODUCTION: Vertebrobasilar insufficiency (VBI) is a condition that results from restricted blood flow to the posterior portions of the brain, which are primarily served by the vertebral and basilar arteries. It is the most common cause of vertigo in the elderly and is usually accompanied by impaired vision and sensation. Congenital abnormalities, atherosclerosis, stroke and/or trauma may all lead to decreased vertebrobasilar circulation. A syndrome called Subclavian Steal Syndrome (SSS), which manifests with similar neurological symptoms but with a different pathophysiology, may also cause VBI...
2015: International Journal of Surgery Case Reports
Santosh Kaur Sangari, Paul-Michel Dossous, Thomas Heineman, Estomih Phillip Mtui
The study was conducted on random sample of seventy-one dried, typical cervical vertebrae (C3-C6). The data on the age, sex, and built was not available. Using vernier calipers with 0.01 mm accuracy, the anteroposterior and transverse diameters of transverse foramina and their distance from the medial margin of the uncinate process were measured bilaterally. The mean diameter of the right/left transverse foramen varied from 2.54 mm to 7.79 mm (mean = 5.55 ± 0.87 mm) and from 2.65 mm to 7.35 mm (mean = 5...
2015: Anatomy Research International
Vaibhav Rastogi, Ashley Rawls, Omar Moore, Benjamin Victorica, Sheema Khan, Pradeepan Saravanapavan, Sunitha Midivelli, Prathap Raviraj, Anna Khanna, Sharathchandra Bidari, Vishnumurthy S Hedna
BACKGROUND: Bow Hunter's Syndrome is a mechanical occlusion of the vertebral artery which leads to a reduction in blood flow in posterior cerebral circulation resulting in transient reversible symptomatic vertebrobasilar insufficiency. CASE DESCRIPTION: We present a case of Bow Hunter's syndrome in a 53-year-old male that occurred after the patient underwent surgical correction of a proximal left subclavian artery aneurysm. Shortly after the surgery, the patient began to complain of transient visual changes, presyncopal spells, and dizziness upon turning his head to the left...
July 2015: Journal of Vascular and Interventional Neurology
Gavin W Britz, Vijay Agarwal, Frank Mihlon, Dinesh Ramanathan, Abhishek Agrawal, Shahid M Nimjee, David Kaylie
BACKGROUND: Vertebrobasilar insufficiency resulting from embolism, atherosclerosis, or arterial dissection has long been a challenge for successful management and outcomes. The main treatment options include medical therapy, angioplasty and stenting, and surgical revascularization. Unlike cardiac or peripheral vascular revascularization, large randomized trials with cerebrorevascularization have not revealed favorable outcomes. In patients who have failed maximal medical therapy, and having persistent debilitating symptomology, cerebral revascularization may still be a viable option...
January 2016: World Neurosurgery
Gary C Brown, Melissa M Brown, David H Fischer
PURPOSE: To assess the character and cause of photopsias in vitreoretinal patients. DESIGN: Cross-sectional study. PARTICIPANTS: A total of 169 consecutive patients (217 eyes) with vitreoretinal disease presenting with a history of photopsias. METHODS: A total of 217 eyes with photopsias in 169 patients were evaluated. Photopsia assessment included (1) laterality (unilateral, bilateral but not simultaneous, bilateral, and simultaneous); (2) morphology (flash, zig-zag, strobe, scintillating scotoma, twinkling, other); (3) color (white, silver, yellow, combination, other); (4) location (temporal, central, other); (5) duration (quick, prolonged, constant, other); (6) frequency; (7) diurnal appearance (day, night, both); (8) stimuli (turning head or eyes, hypoglycemia, hyperglycemia, other); and (9) associated systemic or ocular signs and symptoms (headache, numbness, weakness, vertigo, syncope, diplopia, hypotension, floaters, other)...
October 2015: Ophthalmology
I A Svyatogor, O E Dick, A D Nozdrachev, N L Guseva
In this study, for the first time, the photic driving reaction in patients with different disorders of the functional state of central nervous system caused by cerebrovascular conditions of different severity was examined by wavelet analysis of electroencephalographic (EEG) fragments. The background fragments of EEG in the group of patients with vegetative-vascular dystonia, are characterized by lower values of the wavelet spectrum energy in the alpha range than the fragments in the control group. In patients from the groups of vertebrobasilar insufficiency and atherosclerotic damage of cerebral blood vessels, the values of energy in delta range is even lower...
May 2015: Fiziologiia Cheloveka
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