scholarly journals Lateral Medullary Syndrome Due to Left Vertebral Artery Occlusion in a Boy Postflexion Neck Injury

2019 ◽  
Vol 6 ◽  
pp. 2329048X1986780
Author(s):  
Abdulla Alawadhi ◽  
Christine Saint-Martin ◽  
Christine Sabapathy ◽  
Guillaume Sebire ◽  
Michael Shevell
Keyword(s):  
Magnetic Resonance ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Occlusion ◽  
Neck Injury ◽  
Neurological Deficits ◽  
Left Vertebral Artery ◽  
Ischemic Lesion ◽  
Vertebral Artery Occlusion ◽  
Lateral Medullary Syndrome

Lateral medullary syndrome is rare in pediatrics. It is characterized by neurological deficits due to an ischemic lesion in the lateral medulla. The authors describe a 17-year-old boy who developed lateral medullary syndrome in the context of a hyperflexion neck injury while diving in shallow water with traumatic vascular injury. He had “crossed” neurological deficits above and below the neck. His magnetic resonance angiography showed intra- and extracranial left vertebral artery occlusion and his magnetic resonance imaging showed signal abnormality involving the left lateral medulla and inferomedial cerebellum in keeping with an infarct secondary to left vertebral artery and left posterior inferior cerebellar artery occlusion. Good neurological recovery was observed on heparin therapy started after surgical treatment of traumatic injury. To our knowledge, this is the first reported case of lateral medullary syndrome in a pediatric population related to a flexion neck injury. The authors emphasize the importance of a high level of suspicion for accurate diagnosis.

scholarly journals P.101 Lateral medullary syndrome due to left vertebral artery occlusion in a boy post flexion neck injury

2018 ◽  
Vol 45 (s2) ◽  
pp. S43-S43
Author(s):  
A Alawadhi ◽  
C Saint-Martin ◽  
G Sebire ◽  
M Shevell
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Occlusion ◽  
Neck Injury ◽  
Neurological Deficits ◽  
Tube Placement ◽  
Left Vertebral Artery ◽  
Ischemic Lesion ◽  
Vertebral Artery Occlusion ◽  
Lateral Medullary Syndrome

Background: Wallenberg’s syndrome (WS), or lateral medullary syndrome is rare in pediatrics, but is not uncommon in adults. It is characterized by neurological deficits due to an ischemic lesion in the lateral medulla. Methods: Case report Results: We describe a 17-year-old boy who developed WS in the context of hyperflexion injury to the neck while diving in shallow water with vertebral dissection as a presumed etiology. He had ‘crossed’ neurological deficits above and below the neck. His MRA showed intra and extracranial left vertebral artery occlusion and his MRI showed T2W/FLAIR signal abnormality involving the left lateral medulla and inferomedial aspect of the cerebellum in keeping with infarcts secondary to the left vertebral artery thrombosis and occlusion of the left posterior inferior cerebellar artery. He was started on anti-coagulation after spinal surgery. On discharge, he had persistent dysphagia which prompt a gastrostomy tube placement prior to transfer to a rehabilitation center. Conclusions: Our case demonstrates that WS can occur post flexion injury in the pediatric population. The presence of crossed neurological findings above and below the neck in the context of neck injury is an important diagnostic clue that should prompt imaging study focusing on the brain stem and the posterior fossa vascular structures.

OCCIPITAL ARTERY-TO-POSTERIOR INFERIOR CEREBELLAR ARTERY BYPASS FOR TREATMENT OF BILATERAL VERTEBRAL ARTERY OCCLUSION: THE ROLE OF QUANTITATIVE MAGNETIC RESONANCE ANGIOGRAPHY NONINVASIVE OPTIMAL VESSEL ANALYSIS

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. E779-E781 ◽  
Author(s):  
Robert M. Starke ◽  
Mark Chwajol ◽  
Daniel Lefton ◽  
Chandranath Sen ◽  
Alejandro Berenstein ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Vertebral Artery ◽  
Artery Bypass ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Occlusion ◽  
Occipital Artery ◽  
Vertebrobasilar Insufficiency ◽  
Vertebral Arteries ◽  
Vertebral Artery Occlusion ◽  
Cerebellar Artery

Abstract OBJECTIVE Patients with partial or complete bilateral vertebral artery occlusion often present with signs and symptoms of transient ischemic attacks or infarction. Advances in phase contrast magnetic resonance imaging have led to noninvasive assessment of volumetric blood flow rates and direction that help in the workup and management of these patients. CLINICAL PRESENTATION We present the case of a patient with symptoms of vertebrobasilar insufficiency without previous transient ischemic attacks or stroke. Quantitative magnetic resonance angiography (QMRA) demonstrated bilateral vertebral artery occlusion with reversal of flow in the basilar and vertebral arteries to the level of the posterior inferior cerebellar arteries bilaterally. A prominent right posterior communicating artery filled the basilar artery and proximal vertebral arteries. INTERVENTION The presence of reversal and diminished flow in the basilar and vertebral arteries suggested that occipital artery-to-posterior inferior cerebellar artery bypass would improve posterior circulation, relieve symptoms, and reduce the risk of infarction. Postoperative QMRA and angiography confirmed revascularization, and QMRA confirmed correction of blood flow direction. CONCLUSION This case illustrates the potential of QMRA as part of a comprehensive cerebrovascular assessment, operative planning, and follow-up of patients with vertebrobasilar insufficiency.

scholarly journals The relation of vertebral artery occlusion and intravertebral cleft: a prospective magnetic resonance angiography study

2021 ◽  
Author(s):  
Tianyu Zhang ◽  
Feng Xue ◽  
Yu Kang ◽  
Yanhua Wang ◽  
Peixun Zhang ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Vertebral Artery ◽  
Vertebral Compression Fracture ◽  
Compression Fracture ◽  
Artery Occlusion ◽  
Segmental Artery ◽  
Vertebral Artery Occlusion ◽  
Occlusion Rate ◽  
Segmental Arteries

Abstract PurposeTo detect the relationship between the vertebral artery occlusion and the intravertebral cleft (IVC).MethodsA prospective evaluation of the vertebral segmental artery condition from the T10 to L4 with the magnetic resonance angiography (MRA) was performed in 44 osteoporosis vertebral compression fracture (OVCF) patients. The artery condition was divided into the patency, narrow, occlusion. The lesion segmental occlusion rate (LSOR) and the total occlusion rate (TOR) was calculated. The relation of the vertebral artery occlusion and the IVC formation was assessed with the univariate analysis. ResultsLOSR was 15.34% and TOR was 15.2%. The segmental arteries of the unfractured vertebrae had higher occlusion rate in thoracolumbar levels than non-thoracolumbar levels. Neither lesion levels arteries occlusion nor the total segmental arteries occlusion was associated with the IVC.ConclusionsVertebral compression fracture did not lead to the segmental artery occlusion. The segmental artery occlusion more likely happened in the thoracolumbar levels. The segmental artery occlusion did not lead to the IVC.

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