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Pseudo subclavian steal syndrome: Case report
Sneha Konda1, Samantha Dayawansa1, Soren Singel1
1Department of Neurosurgery, Baylor Scott and White Health Care, Temple, TX 76508, USA.
International Journal of Surgery Case Reports
|October 20, 2015
Summary
Vertebrobasilar insufficiency (VBI) can mimic Subclavian Steal Syndrome (SSS) due to congenital anatomical variations and atherosclerosis. A rare persistent trigeminal artery compensated for poor posterior circulation, but carotid stenosis caused VBI symptoms.
Area of Science:
- Neurology
- Vascular Surgery
- Neuroimaging
Background:
- Vertebrobasilar insufficiency (VBI) involves reduced blood flow to the brain's posterior circulation.
- It is a common cause of vertigo in the elderly, often linked to impaired vision and sensation.
- Causes include congenital issues, atherosclerosis, stroke, trauma, and Subclavian Steal Syndrome (SSS).
Purpose of the Study:
- To present a case where VBI symptoms mimicked SSS due to complex anatomical and vasoocclusive factors.
- To highlight the diagnostic challenges in differentiating VBI from SSS.
Main Methods:
- A case report of a middle-aged female with fainting and vertigo.
- Investigation excluded cardiac, auditory, and autonomic causes.
- CT angiography revealed a persistent right trigeminal artery (PTA), carotid stenosis, vertebral artery atresia, and absent posterior communicating arteries, rather than SSS.
Main Results:
- The patient's symptoms resolved after carotid endarterectomy.
- Findings indicated PTA was the primary blood source for the posterior circulation.
- Atheromatous changes in the carotid artery reduced flow through the PTA, causing VBI.
Conclusions:
- Anatomical variations, like PTA, can be crucial for posterior circulation.
- Vasoocclusive disease, such as carotid stenosis, can compromise these alternative pathways.
- This case underscores the importance of considering both anatomical and hemodynamic factors in VBI diagnosis, especially when symptoms resemble SSS.
