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VULNERABILITY OF VERTEBRAL ARTERY IN CRANIO VERTEBRAL JUNCTION ANOMALIES AND OCCURRENCE OF POSTERIOR CIRCULATION TERRITORY INFARCTS - A RETROSPECTIVE STUDY OF 12 CASES

Gidugu Venkata Ramdas, G. S. Bindra, Ajay Gehlot, S. B. Gaikwad, S. S. Kale

Abstract


Study Design: A retrospective evaluation of 12 cases of posterior circulation territory (PCT) infarcts with co-existing Cranio vertebral junction(CVJ) anomalies.

 

Materials and Methods: 12 patients with PCT infarcts who had associated CVJ anomalies managed at MM Institute of Medical Sciences and Research were retrospectively studied and their data analysed out of 260 cases of CVJ anomalies from 1995 to 2002.

 

Results: This study comprised of 12 patients of CVJ anomalies with posterior circulation infarcts, wherein 8 presented with acute stroke and 4 patients presented with progressive spastic quadriparesis with history of recurrent attacks of vertebra basilar insufficiency (VBI) and PCT infarcts. Plain x-ray of CVJ showed occipitalised Atlas in 8 patients, wherein 6 were mobile and 2 were fixed. Apart from cord compression, other skeletal abnormalities included basilar invagination (BI) (8/12), block vertebra (8/12), deformed and angulated dens in (7/12) cases, disc bulge (2/12), grade I spondylolisthesis (2/12) and dysraphic dorsolumbar spine (1/12). CT/MRI showed evidence of infarct in posterior circulation in all 12 cases. The location was Cerebellar hemispheres (8), Occipital cortex (6) Thalamus (5) in brain stem (7) and more than one part of the above brain structures (see Table 2). DSA in 8/12 and MR angiography 2/12 (2 patients did not undergo vascular imaging) showed abnormality of the vertebral artery mostly in the V3 segment.  Only 5 patients underwent surgery followed by post op immobilization in Philadelphia collar during the study period. None had recurrence of symptoms on follow up varying from 2 months to 2 years.

 

Conclusion:  This is the largest series describing the association of CVJ anomalies with PCT infarcts. It brings out the vulnerability of vertebral artery and high lights the requirement of evaluation of vertebral artery in management of CVJ anomalies on a routine basis and evaluation of CVJ in all cases of VBI to detect a preventable cause of PCT infarcts.

Keywords


PCT infarcts, Craniovertebral Junction anomalies, VBI, Vertebral artery, Infarcts, CVJ.

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