A vertebral artery aneurysm is a rare occurrence in clinical practice and commonly develops after penetrating trauma that disrupts the anatomy of this blood vessel. Risk factors that are infrequently present are hypertension and coronary heart disease. Headaches and altered consciousness are the most common symptoms. The diagnosis is made through imaging studies, such as computed tomography and digital subtraction angiography, but magnetic resonance angiography is considered to be the optimal procedure for evaluating the lesion.
Vertebral artery aneurysms (VAA) primarily develop at the junction of this vessel and the posterior inferior cerebellar artery (PICA) and are responsible for approximately 0.5-3% of all intracranial aneurysms reported in the literature . Penetrating trauma, such as gunshot or stab wounds, is by far the most important cause of VAA, whereas blunt force trauma, atherosclerosis, fractures of the vertebral column, rheumatoid arthritis (RA), and syphilis are described as other potential etiologies . Aneurysms of this vessel might rupture and induce subarachnoid hemorrhage (SAH) or cause infarction on the grounds of ischemia and thromboembolism , but VAAs can arise from previous dissection as well    . The clinical presentation is comprised of two major symptoms - headache and an altered consciousness, ranging from mild changes to severe coma . Other notable signs that are described in patients who suffered from a vertebral artery aneurysm are vertigo, vomiting, nausea, and Wallenberg syndrome (also known as lateral medullary syndrome)  . Some authors report that a pulsating mass may be a feature of a VAA, often accompanied by bruits and thrills that are aggravated when the carotid artery is compressed .
Entire Body System
- Intravenous Administration
Daily intravenous administration of 300 mg of hydrocortisone was started. This treatment was continued and dosage was tapered until the 10th postoperative day. [ncbi.nlm.nih.gov]
- Walking with a Cane
She was able to walk using a cane although her left hand function had not significantly improved. Her swallowing improved to the point that she was able to eat a normal diet. Therefore her PEG tube was removed. [thefreelibrary.com]
- Vascular Disease
diseases I73.0 Raynaud's syndrome I73.00 …… without gangrene I73.1 Thromboangiitis obliterans [Buerger's disease] I73.8 Other specified peripheral vascular diseases I73.89 Other specified peripheral vascular diseases Reimbursement claims with a date [icd10data.com]
Here we report the successful reconstruction of an asymptomatic extracranial left VA aneurysm, highlighting the treatment for extracranial VA aneurysm and showing the superiority of a hybrid operating room in cerebral vascular diseases. [ncbi.nlm.nih.gov]
[…] type I.(2) Management of Extracranial Vertebral Artery Disease The optimal management of occlusive extracranial vertebral artery disease is not well defined. [bcidaho.com]
Face, Head & Neck
For these 88 patients in the vertigo group, there were no other pathologies that would lead to vertigo; hence the authors concluded that such vascular variations could be related to vertigo and dizziness [ 2 ]. [pulsus.com]
A 54-year-old man presented with neck pain, vertigo and loss of balance. [ncbi.nlm.nih.gov]
Other notable signs that are described in patients who suffered from a vertebral artery aneurysm are vertigo, vomiting, nausea, and Wallenberg syndrome (also known as lateral medullary syndrome). [symptoma.com]
Even though two doctors already said it was "vertigo". I called my regular PCP and she told me to come immediately. [vertebralarterydissection.com]
In both types a variety of other unpleasant physical feelings is common, such as dizziness, tension headaches, and feelings... [books.google.com]
This may produce relative cerebral ischemia with neurologic symptoms such as dizziness, blurring of vision, headache, staggering, and occasionally olfactory hallucinations. [jamanetwork.com]
Congenital morphological abnormalities of the distal vertebral arteries (CMADVA) and their relationship with vertigo and dizziness. Med Sci Monit. 2004; 10: CR316–323. Foutrakis GN, Yonas H, Sclabassi RJ. [pulsus.com]
It began with some dizziness which I thought was not entirely abnormal, I thought perhaps I was overexerting myself. I skated off the ice to the bench. The dizziness became more severe and my vision started to blur. [vertebralarterydissection.com]
These symptoms may include: Loss of vision in part or all of both eyes Double vision Vertigo (spinning sensation) Numbness or tingling Nausea and vomiting Slurred speech Loss of coordination, dizziness or confusion Trouble swallowing A drop attack — sudden [ucdmc.ucdavis.edu]
[…] syndrome: Contralateral weakness or paralysis (pyramidal tract) Contralateral numbness (medial lemniscus) Depending upon which areas of the brainstem or cerebellum are experiencing ischemia, the following signs may be present: Limb or truncal ataxia Nystagmus [emedicine.medscape.com]
CNS: Nystagmus, drowsiness, ataxia, dizziness, mental confusion, tremors, insomnia, headache, seizures. CV: Bradycardia, hypotension, cardiovascular collapse, ventricular fibrillation, conjunctivitis, diplopia, blurred vision. [slideshare.net]
The patient was a 10-year-old boy with a 4-year history of left recurrent torticollis, followed by hemiparesis, dysarthria, dysmetria, and tremor. [ncbi.nlm.nih.gov]
- Basal Ganglia Hemorrhage
Clinical followed-up at 5–28 months (mean 14.1 months) was achieved in 36 patients because two patients died of pancreatic cancer and basal ganglia hemorrhage, respectively. No new neurologic deterioration or aneurysm (re)bleeding was observed. [journals.plos.org]
The diagnosis of a vertebral artery aneurysm must be made early on, which is why a thorough clinical and imaging workup is recommended as soon as suspicion toward this medical entity is raised. The physician should first obtain a detailed patient history that evaluates cardiovascular risk factors and the presence of other comorbidities. If penetrating trauma of the posterior cervical area is confirmed, employment of imaging studies is mandatory. Computed tomography (CT) and magnetic resonance imaging (MRI) must be initially performed to assess the surrounding tissues, but in order to make a definite diagnosis of a VAA, vascular-enhancing studies are necessary. CT angiography (CTA), with or without 3D reconstruction, MR angiography (contrast enhanced and 3D reconstruction) and digital subtraction angiography (DSA) have all been recommended in the assessment of the cranial circulation  . Because of the limitations of CTA (overlapping with bony structures and time-consuming) and DSA (limited capacity to reveal atypical aneurysms), MR angiography is considered to be the gold standard  . On these studies, radiologists frequently reveal the "pearl and string sign" - dilation of the vessel in a fusiform pattern with irregular narrowing of the lumen, whereas subarachnoid hemorrhage, thrombosis, or the formation of a vertebral-venous fistula can be observed as well   .
- Mural Thrombus
Excision of vertebral artery aneurysms in patients with emboli from a mural thrombus is recommended. The consequences of vertebral artery ligation and the indications for distal reconstruction are discussed. [ncbi.nlm.nih.gov]
The aneurysm has extensive concentric mural thrombus and fills via a patent neck with a broad based attachment to the subclavian artery. [radiopaedia.org]
Excision of vertebral artery aneurysms in patients with emboli from a mural thrombus is recommended. The consequences of vertebral artery ligation and the indications for distal reconstruction are discussed. © 1992 S. [karger.com]
Advances in endoscopic transnasal surgery have provided an additional approach for the treatment of these difficult lesions. [ncbi.nlm.nih.gov]
Follow-up angiography 4 months and 1 year after treatment, as well as follow-up MRI showed that all goals of the treatment were achieved. [jmedicalcasereports.biomedcentral.com]
prognosis. 10 Fig. 7 A Hamasaki/2014 56/M 5 Proximal endovascular occlusion,. [medsci.org]
The prognosis is generally poor because the rupture rate is extremely high especially with large or giant aneurysms. However, this case had a good clinical course owing to treatment by parent artery occlusion. [ncbi.nlm.nih.gov]
Older individuals and ones with a higher grade of severity when admitted have a higher chance of a poor prognosis. [brain-surgery.com]
The prognosis depends on the course of the underlying lesion. [books.google.com]
Although the natural history of unruptured VA dissection is still unknown, endovascular treatment should be considered for patients with a relatively large or growing aneurysmal dilatation because prognosis of the patients with subsequent SAH is poor. [jstage.jst.go.jp]
The case presented illustrates that this rare condition should be considered in all patients who have neck masses of undetermined etiology. [ncbi.nlm.nih.gov]
Penetrating trauma, such as gunshot or stab wounds, is by far the most important cause of VAA, whereas blunt force trauma, atherosclerosis, fractures of the vertebral column, rheumatoid arthritis (RA), and syphilis are described as other potential etiologies [symptoma.com]
Here, the relation between the basilar tip aneurysm and hypoplastic left vertebral artery, as well as the role of the hypoplasia in vertebrobasilar insufficiency etiology are discussed. [pulsus.com]
No etiological factor of the illness could be found. The clinical signs resembled those of a flap-valve tumor of the IIIrd ventricle. [link.springer.com]
Cervical artery dissection: pathology, epidemiology and management. Thromb Res. 2009 Apr. 123(6):810-21. [Medline]. Raupp SF, Jellema K, Sluzewski M, de Kort PL, Visser LH. Sudden unilateral deafness due to a right vertebral artery dissection. [emedicine.medscape.com]
"Cervical artery dissection: pathology, epidemiology and management". Thromb. Res. 123 (6): 810–21. doi : 10.1016/j.thromres.2009.01.013. PMID 19269682. ^ a b c d e f g h i j k l m n o p q r Debette S, Leys D (July 2009). [en.wikipedia.org]
Intraoperative and postoperative changes in the LSRs provided useful information regarding the pathophysiology of hemifacial spasm. [ncbi.nlm.nih.gov]
Surgical Neuroangiography: Clinical and Interventional Aspects in Adults covers a variety of protocols and strategies combining functional vascular anatomy with a complete appreciation of the various disease processes, their pathophysiology, clinical [books.google.ro]
Stroke: Pathophysiology, Diagnosis and Management. London, England: Churchill Livingstone; 1986. Vol 1: 549-619. Condie J, Shaibani A, Wainwright MS. [emedicine.medscape.com]
However, risk factors and the underlying pathophysiology of vertebral artery dissection and aneurysms differ. [bcidaho.com]
"Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts?". Current Opinion in Neurology. 27 (1): 20–8. doi : 10.1097/wco.0000000000000056. [en.wikipedia.org]
To prevent neurological deficits we employed electrophysiological monitoring while clipping an aneurysm of the vertebral artery. A 64-year-old woman had suffered a sudden severe headache in the morning. [ncbi.nlm.nih.gov]
Basically, trapping of the TL aneurysm is recommended to prevent regrowth. However, contrived proximal clipping is thought to be suitable for some asymptomatic TL aneurysms, which themselves exhibit perforating arteries. [jstage.jst.go.jp]
Prevention See the separate Primary Prevention of Cardiovascular Disease and Cardiovascular Risk Assessment articles. [patient.info]
- Ravi Kumar CV, Palur RS, Satish S, Rao BR. Vertebral artery aneurysms. Neurol India. 2000;48(2):161-163.
- Kao CL, Tsai KT, Chang JP. Large Extracranial Vertebral Aneurysm: with Absent Contralateral Vertebral Artery. Tex Heart Inst J. 2003;30(2):134-136.
- Taha MM, Sakaida H, Asakura F, et al. Endovascular management of vertebral artery dissecting aneurysms: review of 25 patients. Turk Neurosurg. 2010;20(2):126-135.
- Stavrinou LC, Stranjalis G, Stavrinou PC, Bontozoglou N, Sakas DE. Extracranial Vertebral Artery Aneurysm Presenting as a Chronic Cervical Mass Lesion. Case Rep Med. 2010;2010:938219.
- Anand VK, Raila FA, McAuley JR, Reed JM. Large pseudoaneurysm of the extracranial vertebral artery. Otolaryngol Head Neck Surg 1993;109:1057–1060.
- Lee JW, Jung JY, Kim YB, Huh SK, Kim DI, Lee KC. Spontaneous Dissecting Aneurysm of the Intracranial Vertebral Artery: Management Strategies. Yonsei Med J. 2007;48(3):425-432.
- Haneline MT, Rosner AL. The etiology of cervical artery dissection. J Chiropr Med. 2007;6(3):110-120.