Dissection Vertebral Artery Publications (2180)


Dissection Vertebral Artery Publications

Forensic Sci Med Pathol
Forensic Sci Med Pathol 2017 Jan 17. Epub 2017 Jan 17.
Forensic Pathology Unit, Department of Pathology, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK.

Identifying the site of vascular bleeding in fatal cases of traumatic basal subarachnoid hemorrhage (TBSAH) is important, but can be very difficult to achieve when there is extensive blood clot in the posterior cranial fossa. Post mortem angiography in these circumstances has been reported previously but with mixed results, and is rarely used in current practice within the United Kingdom. We have developed a simple and effective post mortem angiography method, using fluoroscopy and clear modern contrast medium, suitable for use in the autopsy room. Read More

Contrast medium was injected through an angiographic catheter positioned (with water filled balloon) in the extracranial vertebral artery (ECVA) just behind the clavicle, whilst the base of the skull and upper cervical spine area was visualized by fluoroscopy following digital subtraction of the bony images. The procedure was developed over a series of 8 TBSAH cases and using unfixed cadaveric specimens. A clear leak point was identified in 3 cases and the likely site indicated in a further fatality (all with tears subsequently confirmed by histology). In 4 cases, the bleeding point was not identified by angiography. In 7 deaths, the anatomy of the upper cervical loops and intracranial course of the vertebral arteries were well delineated by angiography and several small loop segments were documented. In 1 case, with severe degenerative vascular disease, extracranial vessel wall trauma and luminal thrombosis, angiography was unsuccessful above the level of the first cervical (C1) vertebra. Injecting contrast through the internal carotid artery, just above the bifurcation, was also shown to visualize the anterior cerebral circulation well. This method is likely to identify the main site of vascular tearing in about 50% of cases of TBSAH and to delineate the important anatomy of the vessels, prior to dissection of the upper neck and posterior fossa, thus minimizing handling artefacts and guiding the histological sampling of the vessels.

Neurologia 2017 Jan 12. Epub 2017 Jan 12.
Servicio de Neurología, Hospital Universitario Ramón y Cajal, Departamento de Neurología, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Madrid, España.

Cervical artery dissection (CAD) is responsible for up to 20% of all ischaemic strokes in patients younger than 45. The benefits of acute-phase reperfusion therapy in these patients have yet to be confirmed.
We conducted a retrospective review of patients with CAD admitted to a comprehensive stroke centre between 2010 and 2015. Read More

We recorded baseline clinical characteristics, treatments, functional outcomes, and mortality.
We identified 35 cases of CAD (23 carotid/12 vertebral); mean age was 43.5 ± 9.5 years and 67.7% were men. Ten patients (32.3%) had a history of trauma. The most frequent risk factors were arterial hypertension (29%) and smoking (35.5%). The most common clinical presentation was ischaemic stroke (29 patients, 93.5%). The median baseline National Institute of Health Stroke Scale score was 6 (range, 0-41). The most frequently used diagnostic method was CT angiography (74.2%), followed by MRI (64.5%) and digital subtraction angiography (45.6%). Seven patients (22.6%) were treated with intravenous fibrinolysis and 11 (35.5%) with endovascular treatment plus intravenous fibrinolysis; at 3 months, functional independence (modified Rankin Scale scores 0-2) was achieved by 57.1% and 63.6% of these cases, respectively. One patient died (3.2%).
In our sample, the most common form of presentation of CAD was ischaemic stroke. Reperfusion therapy seems to be a safe and effective option for these patients, and outcomes resemble those of other patients with ischaemic stroke. Larger comparative studies are necessary to better assess response to reperfusion therapy in acute ischaemic stroke.

J Stroke Cerebrovasc Dis
J Stroke Cerebrovasc Dis 2017 Jan 11. Epub 2017 Jan 11.
Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.

A 32-year-old woman with osteogenesis imperfecta (OI) was admitted to the hospital because of a right-sided occipital headache and facial paresthesia. She was diagnosed with lateral medullary syndrome due to right vertebral artery (VA) dissection. She was treated conservatively without antithrombotic therapy. Read More

She developed subarachnoid hemorrhage because of contralateral VA dissection 18 days later. This clinical course may reflect the underlying weakness of the vessel wall in OI. In patients with OI, occlusion of a unilateral VA could cause dissection and subsequent rupture of the contralateral VA. Early surgical treatment for lesions of the VA is required in such cases.

Although 20-30% of all strokes occur in the posterior circulation, few studies have explored the characteristics of patients with strokes in the posterior compared to the anterior circulation so far. Especially data on young patients is missing.
In this secondary analysis of data of the prospective multi-centre European sifap1 study that investigated stroke and transient ischemic attack (TIA) patients aged 18-55 years, we compared vascular risk factors, stroke aetiology, presence of white matter hyperintensities (WMH) and cerebral microbleeds (CMB) between patients with ischaemic posterior circulation stroke (PCS) and those having suffered from anterior circulation stroke (ACS) based on cerebral MRI. Read More

We diagnosed PCS in 612 patients (29.1%, 407 men, 205 women) and ACS in 1,489 patients (70.9%). Their age (median 46 vs. 47 years, p = 0.205) and stroke severity (modified Rankin Scale: both 2, p = 0.375, Barthel Index 90 vs. 85, p = 0.412) were similar. PCS was found to be more frequent among the male gender (66.5 vs. 60.1% with ACS, p = 0.003). Vertebral artery (VA) dissection was more often the cause of PCS (16.8%) than was carotid artery dissection of ACS (7.9%, p < 0.001). Likewise, small vessel disease (Trial of Org 10172 in Acute Stroke Treatment [TOAST] = 3, PCS: 14.7%, ACS: 11.8%) and stroke of other determined aetiology (TOAST = 4, PCS: 24.5%, ACS: 16.0%) were more frequent in those with PCS. Furthermore, patent foramen ovale (PFO; PCS: 31.1%, ACS: 25.4%, p = 0.029) was more often detected in patients with PCS. In contrast, large-artery atherosclerosis (TOAST = 1, PCS: 15.4%, ACS: 22.2%) and cardio-embolic stroke (TOAST = 2, PCS: 15.6%, ACS: 18.0%) were less frequent in those with PCS (p < 0.001) as were preceding cerebrovascular events (10.1 vs. 14.1%, p = 0.014), TIA (4.8 vs. 7.7%, p = 0.016) and smoking (53.2 vs. 61.0%, p = 0.001). The presence, extent, and location of WMH and CMB did not differ between the 2 groups.
Our data suggested a different pattern of aetiology and risk factors in young patients with PCS compared to those with ACS. These findings especially call for a higher awareness of VA dissection and potentially for more weight of a PFO as a risk factor in young patients with PCS. Clinical trial registration-URL: http://www.clinicaltrials.gov; NCT00414583.

J Neurointerv Surg
J Neurointerv Surg 2017 Jan 12. Epub 2017 Jan 12.
The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
J Stroke Cerebrovasc Dis
J Stroke Cerebrovasc Dis 2017 Jan 5. Epub 2017 Jan 5.
Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, SP, Brazil.

Man in the barrel syndrome (MBS) is a condition of brachial diplegia initially described after a bilateral watershed cerebral infarct between the anterior and the middle cerebral artery territories.
To report a case of MBS as a consequence of anterior spinal artery infarct due to vertebral artery dissection.
More recently, nonischemic lesions in brain and brain stem have also been described as etiologies of MBS. Read More

There are few reports describing spinal cord infarction leading to MBS. The anterior spinal artery syndrome with only brachial diplegia also represents a rare and atypical pattern.
The conventional neurological consideration that MBS provides a precise anatomical localization is now challenged. The finding of a brachial diplegia leads to the need to investigate the brain, the spinal cord, and the peripheral nervous system.

Spinal Cord Ser Cases
Spinal Cord Ser Cases 2016 7;2:15042. Epub 2016 Apr 7.
Department of Experimental Biomedicine and Clinical Neurosciences (Bionec), School of Medicine, Neurosurgical Clinic, University of Palermo , Palermo, Italy.

We report a case of a giant intra and extradural cervical schwannoma in a patient affected by a severe myelo-radiculopathy. Clinical features, diagnosis and the issues concerning the surgical management of this benign tumor are discussed. We also review similar cases previously reported in the literature. Read More

A 50-year old caucasian woman was complaining of a 1 year of neck pain and worsening motor impairment in all four limbs causing the inability to walk. Neuroradiological assessment revealed a suspected schwannoma involving the nerve roots from C3 to C5, compressing and deviating the spinal cord. The vertebral artery was also encased within the lesion, but still patent. A posterior cervical laminectomy with a microsurgical extradural resection of the lesion was performed. Moreover, an accurate dissection of the lesion from the vertebral artery and the resection of the intraspinal component was achieved. Vertebral fixation with screws on the lateral masses of C3, C5 and C6 and a hook on C1 was performed. The procedure was secured using electroneurophysiological monitoring. A progressive improvement of the motor functions was achieved. A cervical post-contrast MRI revealed optimal medullary decompression and a gross-total resection of the lesion. Schwannomas are benign, slowly growing lesions which may cause serious neurological deficit. Early diagnosis is necessary and it maybe aided by imaging studies such as MRI or CT. The accepted treatment for these tumors is surgical resection and, when indicated, vertebral fixation.

BMJ Case Rep
BMJ Case Rep 2017 Jan 4;2017. Epub 2017 Jan 4.
The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Int. J. Angiol.
Int J Angiol 2016 Dec 18;25(5):e58-e59. Epub 2015 May 18.
Division of Vascular Surgery, Long Island Jewish Medical Center, New Hyde Park, New York.

This report describes a novel anterior surgical approach to the midlumbar spine. A transperitoneal dissection separating the tissue planes between the infrarenal vena cava and abdominal aorta allows for ample exposure in the reconstruction of midlumbar vertebral body fractures. Read More