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[A case of bow hunter's stroke]
I Takahashi1, S Kaneko, K Asaoka
1Department of Neurosurgery, Iwamizawa Municipal General Hospital, Japan.
No to Shinkei = Brain and Nerve
|February 1, 1994
Summary
Vertebrobasilar insufficiency causing vertigo was resolved by surgically decompressing the atlas vertebra, which relieved vertebral artery occlusion during neck rotation. This case highlights surgical decompression as an effective treatment for positional vertebral artery syndrome.
Area of Science:
- Neurology
- Vascular Surgery
- Neurosurgery
Background:
- Vertebrobasilar insufficiency (VBI) can manifest with diverse neurological symptoms, including vertigo and nystagmus.
- Positional occlusion of the vertebral artery, particularly at the C1-C2 level, is a recognized cause of VBI.
- Surgical intervention is considered for VBI refractory to conservative management.
Observation:
- A patient presented with vertigo and horizontal nystagmus specifically induced by neck rotation.
- Cervical spine angiography revealed obstruction of the left vertebral artery at the C1-C2 level during right head rotation.
- The patient underwent surgical decompression via partial transversectomy of the atlas vertebra.
Findings:
- Postoperative angiography confirmed the resolution of vertebral artery occlusion upon neck rotation.
- The patient's symptoms of vertigo and nystagmus were completely relieved following surgical decompression.
- This suggests a direct correlation between the C1-C2 vertebral artery compression and the induced neurological deficits.
Implications:
- Surgical decompression of the atlas vertebra is a viable and effective treatment for positional vertebral artery occlusion at the C1-C2 level.
- This approach can successfully alleviate symptoms of vertebrobasilar insufficiency, such as vertigo and nystagmus.
- Understanding the pathogenesis of positional vertebral artery compression is crucial for appropriate diagnosis and management.