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Mastication Steal Syndrome.
Charles Miles Maliska1, John Blebea1, Kevin E Taubman1
1Department of Surgery, University of Oklahoma College of Medicine, Tulsa, OK.
Annals of Vascular Surgery
|September 27, 2016
Summary
Episodic symptoms like vertigo during meals were linked to external carotid artery (ECA) occlusion. Surgical repair resolved these symptoms, highlighting the importance of blood flow in the head and neck.
Area of Science:
- Vascular Surgery
- Neurology
- Cerebrovascular Disease
Background:
- Cerebrovascular symptoms can arise from complex arterial pathologies.
- External carotid artery (ECA) disease is less common but can cause significant symptoms.
Observation:
- A 56-year-old woman experienced episodic vertigo, dizziness, and diplopia during specific activities like eating and prolonged speaking.
- Diagnostic work-up, including catheter-based angiography, identified an ostial left external carotid artery (ECA) occlusion.
Findings:
- Retrograde flow was observed via a collateral branch from the left vertebral artery, indicating a variant collateral pathway.
- The symptoms were attributed to a symptomatic arterial steal syndrome, where craniofacial muscle activity during ECA-supplied tasks diverted blood flow from the vertebral-basilar system.
Implications:
- Repetitive craniofacial muscular activities can precipitate neurological symptoms in cases of ECA occlusion.
- Surgical intervention, such as left ECA endarterectomy with reimplantation, can effectively resolve these steal syndrome symptoms.
- This case underscores the significance of considering ECA pathology in patients with unexplained episodic neurological deficits related to head and neck activity.
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