Dynamic imaging of the craniovertebral junction is mandatory in patients with posterior circulation strokes
| Autor: | Ari G Chacko, Edmond Jonathan Gandham, Sunithi Alexandar Mani, Krishna Prabhu Raju, Sanjith Aaron, Hemanth Vupputuri |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Vertebral artery 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale medicine.artery medicine Humans Orthopedics and Sports Medicine Vertebrobasilar insufficiency Stroke Retrospective Studies 030222 orthopedics business.industry Retrospective cohort study medicine.disease Spinal Fusion Atlanto-Axial Joint Radiological weapon Etiology Cervical Vertebrae Surgery Radiology Neurosurgery business 030217 neurology & neurosurgery |
| Zdroj: | European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 29(5) |
| ISSN: | 1432-0932 |
| Popis: | The course of the vertebral artery after exiting from the C1 foramen transversarium and prior to entering the dura lends itself to compression in C1-2 instability. However, atlantoaxial dislocation presenting with vertebrobasilar insufficiency and posterior circulation stroke (PCS) is rare.In this retrospective study, we identified 96 patients with PCS who had complete radiological data. Ten (10.4%) patients had craniovertebral junction (CVJ) anomalies, of which six underwent surgery and four were managed conservatively. The clinical and functional outcomes were measured in the two groups.Left-sided strokes were seen in 7/10 patients, the majority of whom had left dominant vertebral arteries. The mean age at presentation in those with CVJ anomalies was 27.2 ± 12.8 years that was significantly lower than those without CVJ anomalies, 52.2 ± 14.5 years (p ≤ 0.001). The etiologies of PCS in those 50 years were CVJ anomalies (30%), atherosclerosis (30%) and vasculitis (27%); however, the overwhelming majority of strokes in the 50 year age group was atherosclerosis (91%). Postoperatively, there were no recurrent strokes in the operated patients, who also obtained significant clinical improvement on the modified Rankin Scale, Nurick Scale and modified McCormick Scale as compared to those who did not undergo surgery.Early diagnosis and surgical treatment of CVJ instability prevent recurrent strokes and improve outcomes in patients with PCS. Physicians and spine surgeons need to be sensitized regarding CVJ anomalies as a cause of PCS enabling early diagnosis with dynamic imaging particularly in the younger age group. These slides can be retrieved under Electronic Supplementary Material. |
| Databáze: | OpenAIRE |
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