The use of dynamic magnetic resonance angiography in the diagnosis of rotational vertebral artery syndrome

Chrisoula Cheronis, Grant L. Lin, Andrew Silverman, Alexandra Johnson, Sarah Lee
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Abstract

Background

Rotational vertebral artery (VA) syndrome represents a rare mechanical vasculopathy that can lead to vertebrobasilar insufficiency and ischemic stroke.

Objective

We describe a 10-year-old boy with a history of chronic morning emesis who presented with acute onset dizziness, gait instability, and vomiting and was diagnosed with acute ischemic posterior circulation stroke.

Interpretation

Contrast-enhanced magnetic resonance angiography (MRA) of the head and neck with dynamic positioning demonstrated loss of flow-related enhancement with head tilted to the left, conferring a diagnosis of rotational VA syndrome. He started aspirin monotherapy and subsequently underwent C1 laminectomy, with both radiographic and clinical improvement on follow-up.

Conclusion

Dynamic contrasted-enhanced MRA imaging can serve as a noninvasive alternative to digital subtraction angiography in the diagnosis of rotational VA syndrome and should be considered in suspected cases of pediatric rotational arteriopathy.

Abstract Image

动态磁共振血管造影在椎动脉旋转综合征诊断中的应用
背景旋转椎动脉(VA)综合征是一种罕见的机械性血管病变,可导致椎基底动脉功能不全和缺血性中风。目的我们描述了一名10岁的男孩,他有慢性晨吐史,表现为急性起病头晕、步态不稳和呕吐,并被诊断为急性缺血性后循环卒中。动态定位的头部和颈部磁共振血管造影(MRA)显示头部向左倾斜时血流相关增强丧失,诊断为旋转VA综合征。他开始阿司匹林单药治疗,随后接受C1椎板切除术,随访时影像学和临床均有改善。结论动态对比增强MRA成像可作为一种无创替代数字减影血管造影诊断旋转VA综合征的方法,在小儿旋转动脉病变疑似病例中应予以考虑。
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