Vertebrobasilar insufficiency

The differential for vertebrobasilar insufficiency is wide and can be caused by posterior circulation infarcts, steal-type phenomena, or other systemic causes. In the absence of imaging findings explaining symptomology, the utility of appropriate history gathering and dynamic angiography cannot be understated in identifying Bow Hunter's syndrome, a rare cause of dynamic vertebrobasilar insufficiency. We present a case of a 69-year-old man who complained of presyncope and severe dizziness when turning his head towards the right...

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A 27-year-old female patient suffered from recurrent episodes of dizziness, visual rotation, and intermittent right-hand numbness over one month. Symptoms persisted and were triggered by rotating the head to the right or left for more than 10 seconds. Neurological examination showed that the symptoms were most pronounced when the head was rotated over 45 degrees to the right. Dynamic digital subtraction angiography (dDSA) was performed to confirm the diagnosis. Leftward head rotation caused occlusion of the right vertebral artery(VA) ...

Symptomatic vertebrobasilar atherosclerotic disease is rarely encountered but represents a high-risk factor for recurrent transient ischemic attack or stroke. Posterior strokes are usually associated with embolism or hemodynamic impairment. Extensive disease involving the V3 and V4 segments of the vertebral artery (VA) remains infrequent, and optimal management is limited owing to the infrequency of this disease. We illustrate the case of a 65-year-old man who presented with recurrent transient episodes of dizziness with acute onset of instability, nausea, and left visual blurring...

Dolichoectasia of the intracranial arteries is a rare condition characterized by elongated and tortuous arteries due to progressive destruction of the vessel walls. Although most patients present with cerebrovascular accidents, our patient presented with intractable facial pain along the distribution of the trigeminal nerve. Clinical examination revealed involvement of the 5th, 7th, and 8th cranial nerves, and subsequent MRI showed dolichoectasia of the left basilar artery. The patient experienced symptomatic relief after a trial of carbamazepine along with botulinum toxin injections...

Bow Hunter's syndrome is a rare condition in which vertebrobasilar circulatory insufficiency develops because of neck rotation. We report a patient with Bow Hunter's syndrome diagnosed by Doppler sonography. This report demonstrates the important role of Doppler sonography in diagnosis of Bow Hunter's syndrome.

Vertebrobasilar dolichoectasia (VBD), a rare posterior circulation vascular variant disease, is an important risk factor for many acute cerebrovascular diseases. An insufficient understanding of VBD often leads to misdiagnose. Two cases of VBD that were initially diagnosed as posterior circulation watershed infarction are reported here. Absence of common causes of stroke including hypoperfusion, blood system diseases, carotid and aortic dissection, and eosinophil elevation, the symptoms of the 2 patients met the diagnostic criteria of VBD...

INTRODUCTION: The Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke (VERiTAS) study determined patients with low flow in their vertebrobasilar (VB) system are at increased risk of recurrent stroke. Endovascular interventions such as angioplasty and stenting are reserved for patients with refractory symptoms; however, few series to date have demonstrated either hemodynamic or clinical outcomes in this high-risk patient group. We present our combined institutional series of patients with symptomatic VB atherosclerotic disease and low-flow state who underwent angioplasty and stenting...

Vertebrobasilar insufficiency (VBI) can lead to devastating brainstem and posterior cerebral infarction without timely treatment.1 A 56-year-old man with history of hypertension, hyperlipidemia, and diabetes mellitus presented to the clinic with right hemiparesis due to previous left cerebral hemispheric stroke. He also harbored a giant asymptomatic parietooccipital meningioma incidentally diagnosed 2-years ago. Neuroimaging showed old left cerebral infarcts and a tumor that had remained stable in size. Cerebral angiography identified bilateral vertebral artery stenosis near their origin from the subclavian arteries with severe vertebrobasilar insufficiency...

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BACKGROUND AND PURPOSE: We aimed to investigate the relationship between the degree and location of vertebrobasilar stenosis and quantitative magnetic resonance angiography (QMRA) distal flow. METHODS: We retrospectively reviewed patients who presented with acute ischemic stroke with ≥50% stenosis of the extracranial or intracranial vertebral or basilar arteries, and QMRA performed within 1 year of stroke. Standardized techniques were used to measure stenosis and to dichotomize vertebrobasilar distal flow status...

OBJECTIVE: To determine whether cervical ultrasonography, magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA) are useful in the differential diagnosis of etiology and understanding the pathophysiology in cases of apogeotropic direction-changing positional nystagmus (DCPN). METHODS: Thirty patients with apogeotropic DCPN were classified into 11 cases of central disease, seven cases of mixed central and peripheral disease, and 12 cases of peripheral disease by differential diagnosis based on various balance function, neuro-otological, and imaging tests...

BACKGROUND: The occurrence of Isolated left subclavian artery (ILSA) is relatively rare, ILSA is caused by the persistence of the dorsal segment of the sixth left arch, with regression of the fourth arch artery and interruption of the left dorsal aorta at the distal end of the seventh intersegmental artery on the left side during embryonic development. The left subclavian artery is connected to the pulmonary artery through an arterial duct, which can be closed or unobstructed. This abnormality can lead to congenital subclavian steal syndrome and vertebrobasilar artery insufficiency...

Paediatric Bow Hunter's syndrome (BHS), or rotational vertebral artery syndrome, is a rare cause of posterior circulation insufficiency in children. It results from mechanical obstruction of the vertebral artery by the transverse process of cervical vertebrae resulting in vertebrobasilar insufficiency during the neck rotation to the sides. Paediatric dilated cardiomyopathy (DCM) is a rare myocardial disease that presents with ventricular dilatation and cardiac dysfunction. This case report describes the successful anaesthetic management of an boy with BHS due to atlantoaxial dislocation and DCM...

Aberrant right subclavian artery (ARSA) is a rare congenital malformation, wherein the aorta gives rise to the right subclavian artery as a branch off the aortic arch distal to the takeoff of the left subclavian artery. We presented a case of a patient with ARSA that manifested vertebrobasilar symptoms. PubMed search was preformed using keywords 'aberrant right subclavian artery', 'right subclavian steal' and 'vertebrobasilar', which generated nine articles. We found only seven case reports through a PubMed search that discuss ARSA in association with Subclavian steal syndrome...

BACKGROUND: Blunt vertebral artery injuries after cervical trauma due to the close anatomical relationship of the vertebral artery to the cervical spine may have fatal consequences because of posterior circulation ischemia and vertebrobasilar insufficiency. While the standard of care remains medical treatment by anticoagulation or antiplatelet therapy, surgical decompression of the vertebral artery is rarely indicated. OBSERVATIONS: The authors present a case of selective decompression of a traumatically constricted vertebral artery within the transverse foramen of C2 presenting with vertebrobasilar insufficiency due to bilateral aplasia of the posterior communicating arteries and contralateral hypoplasia of the vertebral artery...

PURPOSE: This study aimed to explore the differences in diagnosis (Dix-Hallpike test; the head impulse, nystagmus, and the test of skew [HINTS] procedures; imaging modalities; and audiological battery) and treatment (pharmacological treatments and the Epley maneuver) of acute vertigo (AV) by examining the perspectives of otolaryngologists, emergency physicians (EPs), and primary care physicians (PCPs). METHOD: A total of 123 physicians (otolaryngologists [ n = 40], EPs [ n = 41], PCPs [ n = 42]) were included in this study...

Background: Agenesis of the internal carotid artery (ICA) is a rare congenital malformation that is often asymptomatic until the fourth or fifth decade. ICA agenesis is associated with several intracranial pathologies, the most reported being intracranial aneurysms, thought to be attributable to the increased flow in the collateral vessels supplying the anterior circulation. The cause of ICA agenesis is largely unknown and has not been consistently associated with any genetic mutations or syndromes. Case Report: We present the case of a 37-year-old female who was incidentally found to have bilateral agenesis of the ICA system...

INTRODUCTION: Vertebral artery dissection (VAD) is a rare, but life-threatening condition. Compared to the general population, pregnant and postpartum women are more likely to develop VAD. Spontaneous arterial dissections have an ambiguous pathophysiology and may be difficult to manage. This study aimed to pool and analyze the data of published cases in this regard. METHODS: We conducted a literature search on February 24, 2022, using MeSH terms of interest in PubMed, Google Scholar, Ovid, Web of Science, and Scopus databases to find studies on VAD following childbirth...

PURPOSE: Vertebral arteries (VAs) provide blood circulation to the posterior fossa in general and are the main blood supply of the posterior fossa structures of the brain. Our aim in this study is to analyze the segmental volumetric values of cerebellar structures with the voxel-based volumetric analysis system in individuals with unilateral vertebral artery hypoplasia. METHODS: In this retrospective study, segmental volumetric values/percentile ratios of cerebellar lobules were calculated using 3D fast spoiled gradient recall acquisition in steady-state (3D T1 FSPGR) MRI sequence images of the brain in individuals with unilateral vertebral artery hypoplasia (VAH) and in those without bilateral VAH and any symptoms of vertebrobasilar insufficiency as the control group was evaluated in volBrain ( https://volbrain...