Central respiratory dysfunction following vertebral artery dissection

Lanczik, O.; Szabo, Kristina; Lecei, Olivera; Binder, Johannes; Thiel, S. van; Gass, Achim; Hennerici, Michael G.

doi:10.1212/01.wnl.0000203116.81759.6f

Cited by 5 publications

(2 citation statements)

References 6 publications

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“…11 Abnormalities of ventilation have been reported previously in a patient with combined brainstem and cord infarction secondary to VAD. 24 Brown Sequard syndrome is reported uncommonly in association with cervical cord infarction complicating VAD. 9 Bilateral upper extremity amyoatrophy 6 and posterior spinal cord infarction 8 has rarely been described.…”

Section: Discussionmentioning

confidence: 99%

Partial Anterior Cervical Cord Infarction Following Vertebral Artery Dissection

Machnowska

Moien‐Afshari

Voll

et al. 2008

Can. j. neurol. sci.

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Can. J. Neurol. Sci. 2008; 35: 674-677 PEER REVIEWED LETTER vibration from T5 distally. Joint position, graphaesthesia and stereognosis were intact bilaterally. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), electrolytes, fasting glucose, HbA1C, and coagulation tests were unremarkable. Low density lipoprotein (LDL) cholesterol and total cholesterol/ high density lipoprotein (HDL) ratio were high (3.58, and 6.6 respectively). Cortisol and adrenocorticotropic hormone (ACTH) levels were normal. The ECG, cardiac telemetry and cardiac enzymes were normal. An echocardiogram From the

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Section: Discussionmentioning

confidence: 99%

Partial Anterior Cervical Cord Infarction Following Vertebral Artery Dissection

Machnowska

Moien‐Afshari

Voll

et al. 2008

Can. j. neurol. sci.

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“…When performing an anterior approach to the cervical spine it is essential for the surgeon to know what to encounter first when exposing the transverse process: bone or-as in this case-the VA. The potentially devastating complications of VAI with it's supply of cerebellum, brain stem and spinal cord are well known: brain stem infarction [3,12] or central respiratory dysfunction [10].…”

Section: Discussionmentioning

confidence: 99%

Vertebral artery anomaly with entry at C4—avoiding a surgical pitfall: a case report

2008

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We present a case of an unusual course of the vertebral artery (VA) with intra-foraminal entrance at C4. A patient with traumatic fracture of C3 and C4 with dislocation C3/C4, spinal cord compression and ensuing quadriplegia presented with unilateral entrance of the VA at C4 detected on preoperative magnetic resonance imaging (MRI). The patient was surgically decompressed and stabilized by an anterior-posterior approach without intraoperative complications. Apart from anatomical findings no clinical case of entrance of the VA at C4 had been described in recent clinical literature. A physiologic high entrance of the VA is very rare but must be diagnosed preoperatively to avoid potential life threatening complications.Many variations of vertebral artery (VA) anatomy have been reported in the literature. Most commonly vertebral arteries arise from the superoposterior aspect of the first part of subclavian artery and than take a posterior cephalad course to enter the transverse foramen at C6, but other entry levels have been described. Anomalies have been reported with an entry level of C2 [5] and C3 [7,9]. The entry of the VA into the transverse foramen at C4 has been seen in anatomical studies with an incidence of 1-1,4% [1,11]. To our knowledge there is no clinical case report in the literature describing the VA entry at C4.The following case report describes a young man who suffered quadriplegia from a traumatic fracture of C3/C4 with an anomalous entry of the artery into the transverse foramen at C4 on the left in contrast to the usual entry at C6 on the right. Case reportA 52-year-old construction worker fell from a trestle from a height of 2 meters. He was found prone with his head in anteflexion. On initial examination he presented with bradycardia, somnolence and quadriplegia. During rescue he suffered from apnoea and hypotension and required intubation and cardiopulmonary resuscitation (CPR). After cardiopulmonary stabilization he was transferred to our hospital.On initial clinical examination we found an intubated and vitally stable patient with his head still in modest anteflexion. Apart from the supposed cervical lesion no other injury was detected. Initial helical (spiral) CT scan revealed a fracture of C3 including articular processes and the left vertebral arch, a dislocation between C3/C4 and a comminuted fracture of C4 with inclusion of articular processes, the vertebral arch and the left transverse foramen. Close scrutiny of the CT scans demonstrated an unusual course of the left VA. The right VA showed a normal course with entrance into the transverse foramen at C6 but the left VA entered the vertebra at C4 (Figs. 1, 2).

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Caplan¹

2011

Brainstem Disorders

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Central respiratory dysfunction following vertebral artery dissection

Cited by 5 publications

References 6 publications

Partial Anterior Cervical Cord Infarction Following Vertebral Artery Dissection

Partial Anterior Cervical Cord Infarction Following Vertebral Artery Dissection

Vertebral artery anomaly with entry at C4—avoiding a surgical pitfall: a case report

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