Rotational vertebrobasilar insufficiency due to dynamic compression of the dominant vertebral artery by the thyroid cartilage and occlusion of the contralateral vertebral artery at C1-2 level

Guilherme Dabus; Ronald J Gerstle; Matthew Parsons; Dewitte T Cross III; Christopher J Moran; Robert Thompson; Colin P Derdeyn

doi:10.1111/j.1552-6569.2007.00177.x

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Rotational vertebrobasilar insufficiency due to dynamic compression of the dominant vertebral artery by the thyroid cartilage and occlusion of the contralateral vertebral artery at C1-2 level

Journal article

Peer reviewed

Rotational vertebrobasilar insufficiency due to dynamic compression of the dominant vertebral artery by the thyroid cartilage and occlusion of the contralateral vertebral artery at C1-2 level

Guilherme Dabus, Ronald J Gerstle, Matthew Parsons, Dewitte T Cross III, Christopher J Moran, Robert Thompson and Colin P Derdeyn

Journal of neuroimaging, Vol.18(2), pp.184-187

04/2008

DOI: 10.1111/j.1552-6569.2007.00177.x

PMID: 18298678

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Abstract

Vertebrobasilar insufficiency caused by head rotation is an uncommon event. The mechanism is obstruction of the vertebral artery resulting in flow limitation or, less frequently, thromboembolism. CASE DESCRIPTION: A 41‐year‐old male developed dizziness and light‐headedness during chiropractic manipulation when his head was turned to the extreme right position. Computed tomography angiography (CTA) of the neck and selective digital subtraction angiography (DSA) of the vertebral arteries revealed that when the patient turned his head to the extreme right position the dominant right vertebral artery was compressed between the posterior aspect of the thyroid cartilage and anterior aspect of the right transverse process of C6 resulting in focal stenosis, while the left vertebral artery is severely compressed with significant flow limitation at the level of C1–2. Because the patient was healthy and asymptomatic, conservative management was adopted. At the 9‐month follow‐up visit the patient was asymptomatic and able to compensate for his problem avoiding turning his head to the extreme right position. CONCLUSIONS: We present an uncommon case of rotational vertebrobasilar insufficiency (VBI) where the dominant vertebral artery has an anomalous course compressed by the thyroid cartilage at C6 level, associated with contralateral vertebral artery rotational stenosis at C1–2. The patient was successfully managed conservatively.

Head Movements

Cervical Vertebrae - diagnostic imaging

Humans

Vertebrobasilar Insufficiency - diagnostic imaging

Arterial Occlusive Diseases - diagnostic imaging

Male

Tomography, X-Ray Computed

Rotation

Vertebral Artery - diagnostic imaging

Angiography, Digital Subtraction

Aspirin - administration & dosage

Thyroid Cartilage - diagnostic imaging

Adult

Arterial Occlusive Diseases - complications

Vertebrobasilar Insufficiency - etiology

Details

Title: Subtitle: Rotational vertebrobasilar insufficiency due to dynamic compression of the dominant vertebral artery by the thyroid cartilage and occlusion of the contralateral vertebral artery at C1-2 level
Creators: Guilherme Dabus - Massachusetts General Hospital-Harvard Medical School-Division of Interventional Neuroradiology, Boston, Massachusetts 02114, USA. gdabus@partner.org
Ronald J Gerstle
Matthew Parsons
Dewitte T Cross III
Christopher J Moran
Robert Thompson
Colin P Derdeyn
Resource Type: Journal article
Publication Details: Journal of neuroimaging, Vol.18(2), pp.184-187
Publisher: United States
DOI: 10.1111/j.1552-6569.2007.00177.x
PMID: 18298678
ISSN: 1051-2284
eISSN: 1552-6569
Language: English
Date published: 04/2008
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984020761002771

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11 Times Cited - Web of Science