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Vertebral Artery Aneurysm

Aneurysm of Vertebral Artery

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.


Presentation

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 [1]. 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 [2]. Aneurysms of this vessel might rupture and induce subarachnoid hemorrhage (SAH) or cause infarction on the grounds of ischemia and thromboembolism [3], but VAAs can arise from previous dissection as well [4] [5] [6] [7]. The clinical presentation is comprised of two major symptoms - headache and an altered consciousness, ranging from mild changes to severe coma [3]. 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) [3] [5]. 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 [5].

Atrial Septal Defect
  • She had closure of an atrial septal defect via right jugular vein catheterization at 5 years of age.[ncbi.nlm.nih.gov]
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]
Vascular Disease
  • 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]
  • 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]
Shoulder Pain
  • Postoperatively, her right neck and shoulder pain improved, and she was discharged without further neurologic deficits.[ncbi.nlm.nih.gov]
  • Abstract A 31-year-old man presented with a ruptured right extracranial vertebral artery aneurysm associated with neurofibromatosis type 1, manifesting as acute onset of right neck and shoulder pain, and right supraclavicular mass.[ncbi.nlm.nih.gov]
Neck Mass
  • 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]
Suggestibility
  • These results suggest that the elimination of the pulsatile effect of VA aneurysm adjacent to medulla oblongata can improve symptoms caused by aneurysm-related compression.[ncbi.nlm.nih.gov]
  • The headache and aneurysm were both right sided suggesting a possible relationship.[ncbi.nlm.nih.gov]
  • The stent-assisted coil embolization promoted intra-aneurysm flow disruption and stabilized the wall environment, suggesting another strategy for the treatment of partially thrombosed VA aneurysm.[ncbi.nlm.nih.gov]
  • The authors urge the readers to keep in mind the possibility of subclinical spinal arachnoiditis in the patients with aneurysmal subarachnoid hemorrhage and suggest that care should be taken to avoid any possible adverse effect of fibrin glue.[ncbi.nlm.nih.gov]
  • There were no clinical features suggesting a vascular origin for the lesion. The computed tomographic and standard magnetic resonance imaging scans showed a C5-C6 contrast-enhancing lesion responsible for bony erosion.[ncbi.nlm.nih.gov]
Anger
  • Electronic address: [email protected] 2 Department of Vascular Surgery, CHU de Lille, Lille, France. 3 Departement of Vascular Surgery, Vascular Surgery Unit, CHU de Tours, Tours, France. 4 Department of Vascular Surgery, CHU d'Angers, Angers,[ncbi.nlm.nih.gov]
Vertigo
  • A 54-year-old man presented with neck pain, vertigo and loss of balance.[ncbi.nlm.nih.gov]
  • 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]
  • 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]
  • Summary The case of a 47-year-old man who died one month after a history of paroxysmal occipital headaches, vertigo, vomiting, weakness, and sweating is presented.[link.springer.com]
Dizziness
  • In both types a variety of other unpleasant physical feelings is common, such as dizziness, tension headaches, and feelings... ‏[books.google.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]
  • This may produce relative cerebral ischemia with neurologic symptoms such as dizziness, blurring of vision, headache, staggering, and occasionally olfactory hallucinations.[jamanetwork.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]
Tremor
  • CLINICAL PRESENTATION: 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]
Dysmetria
  • CLINICAL PRESENTATION: 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]

Workup

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 [4] [6]. 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 [4] [6]. 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 [3] [4] [6].

Treatment

  • Abstract Vertebral artery aneurysms form a group of aneurysms having high rates of rebleeding, morbidity, and mortality, poor treatment outcomes, as well as low rate of surgical treatment.[ncbi.nlm.nih.gov]
  • Advances in endoscopic transnasal surgery have provided an additional approach for the treatment of these difficult lesions.[ncbi.nlm.nih.gov]
  • This is a very rare condition in childhood, and it was resolved successfully with endovascular treatment.[ncbi.nlm.nih.gov]
  • BACKGROUND: Endovascular therapy is becoming an increasingly popular treatment for cerebral aneurysms.[ncbi.nlm.nih.gov]
  • Extracranial vertebral artery aneurysm is rare, but the mortality of ruptured cases is extremely high, so early diagnosis and early treatment are important. The present case shows that endovascular treatment was very effective.[ncbi.nlm.nih.gov]

Prognosis

  • 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. Copyright 2016 Elsevier Ireland Ltd.[ncbi.nlm.nih.gov]
  • The prognosis depends on the course of the underlying lesion. ‏[books.google.com]
  • Older individuals and ones with a higher grade of severity when admitted have a higher chance of a poor prognosis.[brain-surgery.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]
  • Early treatment seems essential for improving prognosis in these patients. 12 However, surgery for aneurysms of the VA-PICA traditionally has been performed in a delayed fashion, several days to weeks after SAH. 1 Treatment of an arterial dissection by[ajnr.org]

Etiology

  • 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]
  • We report a 29-year-old man with a symptomatic proximal extracranial vertebral artery aneurysm of unclear etiology. This patient's aneurysm was definitively treated after a successful balloon occlusion test of his affected vertebral artery.[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]

Pathophysiology

  • 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]

Prevention

  • The patient was treated with endovascular coil embolization to prevent re-rupture. Postoperatively, her right neck and shoulder pain improved, and she was discharged without further neurologic deficits.[ncbi.nlm.nih.gov]
  • 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]
  • If the dissection site was demonstrated to be enlarged on magnetic resonance imaging and magnetic resonance angiography without the manifestation of new symptoms, the patients received additional treatment to prevent bleeding.[ncbi.nlm.nih.gov]
  • Prevention See the separate Primary Prevention of Cardiovascular Disease and Cardiovascular Risk Assessment articles.[patient.info]
  • Treatment involves preventing the complications of clots by administering anticoagulants, at first intravenously and then orally for three to six months.[nytimes.com]

References

Article

  1. Ravi Kumar CV, Palur RS, Satish S, Rao BR. Vertebral artery aneurysms. Neurol India. 2000;48(2):161-163.
  2. Kao CL, Tsai KT, Chang JP. Large Extracranial Vertebral Aneurysm: with Absent Contralateral Vertebral Artery. Tex Heart Inst J. 2003;30(2):134-136.
  3. 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.
  4. 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.
  5. Anand VK, Raila FA, McAuley JR, Reed JM. Large pseudoaneurysm of the extracranial vertebral artery. Otolaryngol Head Neck Surg 1993;109:1057–1060.
  6. 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.
  7. Haneline MT, Rosner AL. The etiology of cervical artery dissection. J Chiropr Med. 2007;6(3):110-120.

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Last updated: 2018-06-21 21:42