Rotational vertebral artery occlusion in a patient with basilar invagination
| Autor: | Yunxin Hu, Hui Yang, Zeyan Bao, Shuisheng Zhong |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Foramen magnum
medicine.medical_specialty Neck pain medicine.diagnostic_test business.industry Vertebral artery Infarction Basilar invagination Magnetic resonance imaging General Medicine medicine.disease Asymptomatic 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure 030220 oncology & carcinogenesis medicine.artery Occlusion medicine Surgery Neurology (clinical) Radiology medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | British journal of neurosurgery. |
| ISSN: | 1360-046X |
| Popis: | Basilar invagination (BI) is a congenital or acquired craniovertebral junction (CVJ) anomaly with odontoid process superiorly migrating into the foramen magnum. Compression of neural structures is the most relevant complication of BI. However BI is also a rare cause of ischemic stroke. In this case we reported a 30-year-old female with BI who developed recurrent ischemic stroke in posterior circulation. Before the onset of ischemic stroke, she didn't present neck pain or clinical signs of lower cranial nerve dysfunction, brainstem compression or transient ischemic attack. At first she suffered from sudden onset of left-sided hemidysesthesia. Magnetic resonance imaging from a local hospital revealed an acute infarction in the right thalamus. Cerebral MR angiography was unremarkable at that time. The tip of the odontoid process had protruded into the foramen magnum and could be observed at the level of the lower medulla, but unfortunately it was ignored by the clinicians and the radiologists. She was given antiplatelet therapy and the sensory disturbance disappeared gradually. However she experienced a recurrence in the pontine and midbrain region 2 months later. At this time she was transferred to our hospital, and reconstructed computed tomography of cervical spine demonstrated basilar invagination, atlanto-axial dislocation, and atlanto-occipital assimilation. Computed tomographic angiography (CTA) revealed a dominant right vertebral artery (VA) and a redundant loop in its third segment. Dynamic cerebral angiogram demonstrated that the patient had a Bow Hunter's type phenomenon, with dynamic occlusion of the right dominant VA during contralateral head turn. This case highlighted the necessary of hemodynamic evaluation in asymptomatic basilar invagination. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|