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Rotational vertebral artery occlusion : Mechanism amd long term outcome

Cited 36 time in Web of Science Cited 42 time in Scopus
Authors
Choi, Kwang-Dong; Choi, Jae-Hwan; Kim, Ji-Soo; Kim, Hyo Jung; Kim, Min-Ji; Lee, Tae-Hong; Lee, Hyung; Moon, In Soo; Oh, Hui Jong; Kim, Jae-Il
Issue Date
2013-05-21
Publisher
American Heart Association, Inc.
Citation
Stroke Vol.44 No.7, pp. 1817-1824
Keywords
복합학mechanismprognosisrotational vertebral artery occlusionstroke
Abstract
Background and Purpose—To elucidate the mechanisms and prognosis of rotational vertebral artery occlusion (RVAO).
Methods—We analyzed clinical and radiological characteristics, patterns of induced nystagmus, and outcome in 21 patients (13 men, aged 29–77 years) with RVAO documented by dynamic cerebral angiography during an 8-year period at 3 University Hospitals in Korea. The follow-up periods ranged from 5 to 91 months (median, 37.5 months). Most patients (n=19; 90.5%) received conservative treatments.
Results—All the patients developed vertigo accompanied by tinnitus (38%), fainting (24%), or blurred vision (19%). Only 12 (57.1%) patients showed the typical pattern of RVAO during dynamic cerebral angiography, a compression of the dominant vertebral artery at the C1-2 level during contralateral head rotation. The induced nystagmus was mostly downbeat with horizontal and torsional components beating toward the compressed vertebral artery side. None of the patients with conservative treatments developed posterior circulation stroke, and 4 of them (21.1%) showed resolution of symptoms during the follow-ups.
Conclusions—RVAO has various patterns of vertebral artery compression, and favorable long-term outcome with conservative treatments. In most patients with RVAO, the symptoms may be ascribed to asymmetrical excitation of the bilateral labyrinth induced by transient ischemia or by disinhibition from inferior cerebellar hypoperfusion. Conservative management might be considered as the first-line treatment of RVAO.
ISSN
0039-2499 (print)
1524-4628 (online)
Language
English
URI
http://hdl.handle.net/10371/83758

http://stroke.ahajournals.org/content/44/7/1817
DOI
https://doi.org/10.1161/STROKEAHA.113.001219
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)Journal Papers (저널논문_의학과)
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