Foramen Transversarium Enlargement Due to Tortuosity of the Vertebral Artery

Freilich, Mark; Virapongse, Chat; Kier, E. Leon; Sarwar, Mohammad; Bhimani, Sultan

doi:10.1097/00007632-198601000-00030

Cited by 24 publications

(11 citation statements)

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“…Very rarely, a VA loop causes direct nerve root compression into the nerve root foramen, resulting in its dilation. The foramen may be normally wide (5,6,13,15,17,33,34); however, the differential diagnosis of a cervical radiculopathy in which magnetic resonance imaging or CT scan shows a widened foramen should include lesions such as aneurysms, arteriovenous malformations, and neoplastic or malformative processes (7,8,10,12,24,(29)(30)(31). The efficacy of microvascular decompression in managing other painful cranial nerve syndromes is well recognized (18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

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Vertebral Artery Loop—A Cause of Cervical Radiculopathy

et al. 2012

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Section: Discussionmentioning

confidence: 99%

“…Vertebral artery (VA) anomaly or tortuosity is a rare cause of cervical radiculopathy (2,5,6,9,11,13,14,16,17,22,(33)(34)(35)(36)(37)(38). It may be congenital or acquired, and it is usually detected incidentally as part of investigation for trauma or cervical pain.…”

Section: Introductionmentioning

confidence: 99%

Vertebral Artery Loop—A Cause of Cervical Radiculopathy

et al. 2012

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“…In the chronic phase, the dilation of the arteries may lead to the widening of the canals that they pass through [22]. If any vasodilation had existed during a migraine episode, it might have caused widening of the spinous foramen that the vessel passes through, and this might be considered an indirect finding.…”

Section: Discussionmentioning

confidence: 99%

Is Migraine Related to Medial Meningeal Artery and Spinous Foramen Caliber?

Nalbant¹

2017

Ann Clin Anal Med

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ÖzetAmaç: Migren, tüm başağrısı hastalıkları içinde doktora en fazla başvuru nedenlerinden birisidir ve günümüzde halen migren tanısı için özel bir laboratuvar testi veya radyolojik inceleme yoktur. Migren ağrısında altta yatan mekanizmanın medial meningeal arter vazodilatasyonun neden olduğuna dair geniş bir inanç vardır. Öte yandan son zamanlarda pek çok hipotez vazodilatasyonun rolünü azaltmaktadır. Atak sırasında medial meningeal arterde dilatasyon gelişiyorsa kronik dönemde içinden geçtiği forameni de genişletebilir.Çalışmamızda bu fikirden yola çıkarak migren tanısı olan hastalarda kontrol grubuna göre medial meningeal arter çapı ile spinöz foramen alanında farklılık olup olmadığının araştırılması amaçlandı. Gereç ve Yöntem: Çalışmaya migrenli 36 hasta ve kontrol grubu olarak gerilim tipi baş ağrısı olan 26 hasta alındı. Hastalara çok kesitli beyin BT (bilgisayarlı tomografi) anjiografi tetkiki yapıldı. Migrenli olgular ile kontrol grubu olgularının tümünde her iki taraf medial meningeal arter ve spinöz kanal alanı ölçüldü. Bulgular: Migren hastaları ile kontrol grubunun medial meningeal arter çapı ve spinöz kanal alanı ölçümleri arasında istatistiksel olarak anlamlı farklılık saptanmadı. Tartış-ma: Çalışmamızda migren patofizyolojisinde dura materi besleyen damarlardaki vazodilatasyonun etken olduğunu gösterecek bulgu saptanmadı. Bu sonuç migren patofizyolojisinde ve etyolojisinde farklı hipotezlerin araştırılma-sı gerektiğini göstermesi açısından önemlidir. Anahtar KelimelerMigren; Meningeal Arter; BT Anjiografi Abstract Aim: Although migraine is one of the headache disorders for which people most often consult a doctor, it still does not have a specific diagnostic laboratory or radiologic test. Vasodilation of the medial meningeal artery is widely believed to cause migraines. However, some current hypotheses decrease the role of the vasodilation. If the medial meningeal artery dilates during attacks, in the long term it can expand the foramen pass through. Based on this idea, our study investigated whether there is a significant difference between the medial meningeal artery and spinous foramen sizes of migraine patients compared with a control group. Material and Method: Thirty-six migraine patients and 26 tension-type headache (TTH) patients as the control group were involved in the study. Patients were scanned with brain CT (computed tomography) angiography. The medial meningeal artery and spinous foramen sizes of both groups were measured. Results: There was no statistically significant difference between the measurements of migraine and tension-type headache patients. Discussion: In our study we could not find any evidence to show vasodilation of the dura mater's vasculature as a factor of migraine pathophysiology. This result indicates the need to continue investigating the different hypotheses for migraine pathophysiology.

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“…Variations of the pretransverse segment of the VA have been described extensively, concerning origin [1,2,11,13], tortuosity in its course [6,11,15] and entry in the transverse foramen [1,5,7,9,11]. Entry in the transverse foramen varies from C7 up to C2 [5,7,9].…”

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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Foramen Transversarium Enlargement Due to Tortuosity of the Vertebral Artery

Cited by 24 publications

References 0 publications

Vertebral Artery Loop—A Cause of Cervical Radiculopathy

Vertebral Artery Loop—A Cause of Cervical Radiculopathy

Is Migraine Related to Medial Meningeal Artery and Spinous Foramen Caliber?

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

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