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Cara L. Sedney and Charles L. Rosen

. Acquisition of data: Sedney. Analysis and interpretation of data: Sedney, Rosen. Drafting the article: Sedney. Critically revising the article: Rosen. Reviewed final version of the manuscript and approved it for submission: both authors. References 1 Cushing KE , Ramesh V , Gardner-Medwin D , Todd NV , Gholkar A , Baxter P , : Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra: a possible cause of vertebral artery dissection in children . Dev Med Child Neurol 43 : 491 – 496 , 2001 10.1017/S0012162201000901

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Douglas J. Quint and Eric M. Spickler

V ertebral artery dissection is usually temporally related to an accidental or intentional traumatic event, but it may also be spontaneous. 3, 9 Prompt accurate diagnosis is important so that appropriate treatment can be instituted. 6, 9 The “gold standard” for diagnosis has been vertebral angiography. 1 Recent work with both spin-echo and gradient refocused echo magnetic resonance (MR) imaging has been successful in characterizing some vascular lesions. 4, 7, 11 We report the MR appearance in two cases of vertebral artery dissection confirmed with

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J. Jeffrey Alexander, Seymour Glagov, and Christopher K. Zarins

cranial nerve defects, Horner's syndrome, quadriplegia, and sudden death have been described. 13 This report documents a case of vertebral artery dissection resulting from a traumatic endotracheal intubation. Successful arterial reconstruction of this unusual lesion has, to our knowledge, not been reported previously. Case Report This 38-year-old nurse had a diagnosis of Samter's syndrome: 12 steroid-dependent asthma, nasal polyposis, and acetylsalicylic acid sensitivity. Her prior medical history included multiple nasal polypectomies and a prolonged course of

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Hidenori Endo, Yasushi Matsumoto, Ryushi Kondo, Kenichi Sato, Miki Fujimura, Takashi Inoue, Hiroaki Shimizu, Akira Takahashi, and Teiji Tominaga

data: Endo, Matsumoto, Kondo, Sato. Analysis and interpretation of data: Endo, Matsumoto, Kondo, Sato. Drafting the article: Endo. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Endo. Statistical analysis: Endo. Study supervision: Shimizu, Takahashi, Tominaga. References 1 Ahn JY , Han IB , Kim TG , Yoon PH , Lee YJ , Lee BH , : Endovascular treatment of intracranial vertebral artery dissections with stent placement or

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Chifumi Kitanaka, Tadashi Morimoto, Tomio Sasaki, and Kintomo Takakura

A n increasing number of surgically treated cases of vertebral artery dissection are currently being reported. The accepted surgical technique for such cases is proximal clipping of the dissected vertebral artery; trapping of a dissected artery has rarely been performed. Fortunately, there have been no reports of rebleeding after appropriate proximal clipping. We present a case of vertebral artery dissection that rebled in spite of appropriate proximal clipping. This case indicates that the surgeon should exercise caution in treating vertebral artery

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Hidetoshi Matsukawa, Motoharu Fujii, Masaki Shinoda, Osamu Takahashi, Daisuke Yamamoto, Atsushi Murakata, and Ryoichi Ishikawa

of the manuscript and approved it for submission: all authors. Statistical analysis: Matsukawa, Takahashi. Administrative/technical/material support: Yamamoto. Study supervision: Shinoda, Fujii, Murakata, Ishikawa. References 1 Arnold M , Kurmann R , Galimanis A , Sarikaya H , Stapf C , Gralla J , : Differences in demographic characteristics and risk factors in patients with spontaneous vertebral artery dissections with and without ischemic events . Stroke 41 : 802 – 804 , 2010 2 Etminan N , Beseoglu K , Steiger HJ , Hänggi

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Jacob Cherian, Thomas P. Madaelil, Frank Tong, Brian M. Howard, C. Michael Cawley, and Jonathan A. Grossberg

The video highlights a challenging case of bilateral vertebral artery dissection presenting with subarachnoid hemorrhage. The patient was found to have a critical flow-limiting stenosis in his dominant right vertebral artery and a ruptured pseudoaneurysm in his left vertebral artery. A single-stage endovascular treatment with stent reconstruction of the right vertebral artery and coil embolization sacrifice of the left side was performed. The case highlights the rationale for treatment and potential alternative strategies.

The video can be found here: https://youtu.be/e0U_JE2jISw.

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Van V. Halbach, Randall T. Higashida, Christopher F. Dowd, Kenneth W. Fraser, Tony P. Smith, George P. Teitelbaum, Charles B. Wilson, and Grant B. Hieshima

vertebral artery dissections have been treated conservatively in a few cases; 40 however, the majority have undergone surgical therapy. Since dissecting aneurysms of the vertebral artery are usually fusiform, surgical recommendations have included proximal clip occlusion of the affected artery when the opposite vertebral artery was equal in size or larger. 52 When the affected vertebral artery is dominant, wrapping is often advocated. 6, 35, 43, 50 Occlusion of the dominant vertebral artery and even both vertebral arteries can be tolerated in some instances; 26, 46

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VV , Higashida RT , Dowd CF , et al : Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg 79 : 183 – 191 , 1993 Halbach VV, Higashida RT, Dowd CF, et al: Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg 79: 183–191, 1993 2. Lopéz JR , Chang SD , Steinberg GK : The use of electrophysiological monitoring in the intraoperative management of intracranial aneurysms. J Neurol Neurosurg Psychiatry 66 : 189 – 196

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Chifumi Kitanaka, Jun-Ichi Tanaki, Masanori Kuwahara, Akira Teraoka, Tomio Sasaki, and Kintomo Takakura

determine the optimum management of this pathological condition, it is essential to know both the published surgical results and the outcome of nonsurgical treatment. Although many reports have described the results in surgical series, there has been no large study focusing on the nonsurgical alternative. Thus, the major purpose of this study was to demonstrate the feasibility of nonsurgical treatment using the experience gained in our six cases of intracranial vertebral artery dissection. Most of these cases were followed angiographically, and these results are also