Mechanical compression of the extracranial vertebral artery during neck rotation

Sakaguchi, Manabu; Kitagawa, Kazuo; Hougaku, Hidetaka; Hashimoto, Hiroyuki; Nagai, Yukihiro; Yamagami, Hiroshi; Ohtsuki, Toshiho; Oku, Naohiko; Hashikawa, Kazuo; Matsushita, Kazuhito; Matsumoto, Minako; Hori, Mizuyo

doi:10.1212/01.wnl.0000078081.12097.ae

Cited by 59 publications

(41 citation statements)

References 10 publications

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“…125,126,131,[144][145][146][147] A case series using arteriography displayed partially obstructed blood flow through the contralateral VA at C1 to C2 during head rotation in patients with suspected vertebrobasilar artery ischemia. 146,147 Subsequent studies using duplex sonography have shown no significant change in blood flow in the VA during rotation, 126 simulated manipulation position, 125 and nonthrust manipulation.…”

Section: Strokementioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

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3155Purpose-Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults.The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. Results-Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.

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Section: Strokementioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

View full text Add to dashboard Cite

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“…9,10 In addition, dynamic imaging studies show that the VA is compressed and even occluded at the extracranial portion during contralateral head rotation. 12,13 These reasons support direct mechanical injury of the extracranial vessels as the etiology for golf-related stroke.…”

Section: Discussionmentioning

confidence: 96%

Preferential Location for Arterial Dissection Presenting as Golf-Related Stroke

Choi

Hong

Lee

et al. 2013

American Journal of Neuroradiology

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SUMMARY:Golf-related stroke has not been systematically reviewed. The purpose of our study was to describe in detail this particular stroke syndrome. Seven patients were analyzed at a university hospital and 7 patients were reviewed from MEDLINE literature. General demographics, symptom onset, neurologic signs, radiologic findings, and outcome were investigated. A total of 14 patients including 7 patients from the MEDLINE search were analyzed; all were men, with a mean age of 46.9 Ϯ 12.8 years. Symptom onset was classified as during the golf swing (n ϭ 9), unknown (n ϭ 3), and after playing golf (n ϭ 2). Most patients (n ϭ 12) showed involvement of the vertebral artery and 2 patients showed involvement of the internal carotid artery (P ϭ .008). Nine dissections were found on the right side, 3 on the left side, and 2 were bilateral (P ϭ .046). Twelve patients had extracranial involvement and 2 patients had intracranial involvement (P ϭ .008). Seven patients returned to normal, 5 returned to independence, 1 had unknown status, and 1 died. The anatomic preference of golf-related craniocervical arterial dissection is associated with the extracranial and vertebrobasilar system with a right-sided tendency as the result of stereotypical rotational movement during a golf swing. ABBREVIATION: VA ϭ vertebral artery

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“…3,20 During head rotation, decreased blood flow to the lower portion of the cerebellum supports transient ischemia of the inferior cerebellum in patients with RVAO. 17,23,38 Inferior cerebellar infarction in the territory of PICA is a common cause of isolated vertigo, and the horizontal component of spontaneous nystagmus is mostly ipsilesional in unilateral PICA infarction. 39 The downbeat and ipsiversive horizontal and torsional nystagmus may be explained by transient activation of the ipsiversive horizontal and anterior canal pathways because of disinhibition induced by ischemic insult to the flocculovestibular inhibitory pathways.…”

Section: Strokementioning

confidence: 99%

Rotational Vertebral Artery Occlusion

Choi

Choi²,

Kim³

et al. 2013

Stroke

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Background and Purpose-To elucidate the mechanisms and prognosis of rotational vertebral artery occlusion (RVAO). Methods-We analyzed clinical and radiological characteristics, patterns of induced nystagmus, and outcome in 21 patients (13 men, aged 29-77 years) with RVAO documented by dynamic cerebral angiography during an 8-year period at 3 University Hospitals in Korea. The follow-up periods ranged from 5 to 91 months (median, 37.5 months). Most patients (n=19; 90.5%) received conservative treatments. Results-All the patients developed vertigo accompanied by tinnitus (38%), fainting (24%), or blurred vision (19%).Only 12 (57.1%) patients showed the typical pattern of RVAO during dynamic cerebral angiography, a compression of the dominant vertebral artery at the C1-2 level during contralateral head rotation. The induced nystagmus was mostly downbeat with horizontal and torsional components beating toward the compressed vertebral artery side. None of the patients with conservative treatments developed posterior circulation stroke, and 4 of them (21.1%) showed resolution of symptoms during the follow-ups. Conclusions-RVAO has various patterns of vertebral artery compression, and favorable long-term outcome with conservative treatments. In most patients with RVAO, the symptoms may be ascribed to asymmetrical excitation of the bilateral labyrinth induced by transient ischemia or by disinhibition from inferior cerebellar hypoperfusion. Conservative management might be considered as the first-line treatment of RVAO. (Stroke. 2013;44:1817-1824.)

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Mechanical compression of the extracranial vertebral artery during neck rotation

Cited by 59 publications

References 10 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Preferential Location for Arterial Dissection Presenting as Golf-Related Stroke

Rotational Vertebral Artery Occlusion

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