Bilateral sub-axial rotational vertebral artery occlusion in a setting of a prior cervical construct.

Bilateral sub-axial rotational vertebral artery occlusion in a setting of a prior cervical construct.

World Neurosurg. 2016 Sep 5;

Authors: Felbaum DR, Ryan JE, Stemer AB, Anaizi AN

Abstract
Rotational vertebral artery occlusion (RVAO) or bow hunter's syndrome most commonly affects the C1-2 level due to its importance in regulating rotational movement. We present a 50-year old man who had undergone several prior sub-axial cervical spine operations with increasing neck pain and severe symptoms of vertebrobasilar insufficiency with bi-directional head rotation. Dynamic cerebral angiography demonstrated complete occlusion of left vertebral artery during head rotation to the right, and complete occlusion of the right vertebral artery during head rotation to the left. Occlusions occurred at the level and rostral to his prior construct, with immediate recurrence of debilitating vertigo and near-syncope. Successful radiographic and clinical resolution of symptoms was achieved by posterior instrumentation and fusion from C2, connecting to his prior hardware. A brief literature review and treatment options will be discussed for this unusual presentation of a rare clinical entity.

PMID: 27609452 [PubMed - as supplied by publisher]

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