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Rotational Vertebral Artery Dissection Secondary to Anomalous Entrance into Transverse Foramen.

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Rotational Vertebral Artery Dissection Secondary to Anomalous Entrance into Transverse Foramen.

World Neurosurg. 2017 Dec;108:998.e1-998.e5

Authors: Johnson SA, Ducruet AF, Bellotte JB, Romero CE, Friedlander RM

Summary
BACKGROUND: Rotational vertebral artery occlusion is a uncommon syndrome characterised by vertebrobasilar insufficiency secondary to position-dependent occlusion of the vertebral artery. Most circumstances reported within the literature have been attributed to osteophytic compression, both from the occipital condyle or inside the transverse foramen. Nonetheless, vertebral artery dissection secondary to movement within the setting of anomalous anatomy has not been reported.
CASE DESCRIPTION: To the authors’ information, rotational vertebral artery occlusion and dissection secondary to anomalous entrance into the transverse foramen have by no means been reported. The authors describe the case of a 42-year-old male who introduced with a number of posterior circulation transient ischemic assaults. Normal digital subtraction cerebral angiography demonstrated a non-flow-limiting proper vertebral artery dissection, whereas dynamic digital subtraction cerebral angiography was exceptional for proper vertebral artery stenosis that worsened with neck rotation. Computed tomography angiography of the neck revealed an anomalous course of the best vertebral artery, which entered the transverse foramen at C4 with preforaminal compression by the anterior tubercle of the C5 transverse course of. The affected person had no additional symptomatic occasions after decompression of the vertebral artery by resecting the anterior C5 tubercle.
CONCLUSIONS: Within the setting of codominant vertebral circulation and unilateral bony compression, the authors suggest that neck rotation led to vertebral artery trauma, inflicting dissection sophisticated by thromboembolism. It is a novel and weird entity that’s totally different from Bowhunter’s syndrome.

PMID: 28943421 [PubMed – indexed for MEDLINE]

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