From the Research
In vertebral artery occlusion, symptoms typically occur on the same side (ipsilateral) as the occluded artery, but can also occur on the contralateral side due to rotational vertebral artery occlusion, as seen in the "bow hunter syndrome" 1. The most common symptoms include dizziness, vertigo, nausea, vomiting, and facial pain, which can be ipsilateral or contralateral to the occluded artery. Patients may also experience difficulty swallowing, hoarseness, and Horner's syndrome (characterized by miosis, ptosis, and anhidrosis), as well as contralateral loss of pain and temperature sensation in the body, and ipsilateral loss of pain and temperature sensation in the face. This pattern of symptoms occurs because the vertebral arteries supply blood to the brainstem, cerebellum, and posterior portions of the brain, and when blood flow is interrupted, the structures supplied by that artery become ischemic, leading to neurological deficits. The specific constellation of symptoms, known as the lateral medullary syndrome or Wallenberg syndrome, reflects damage to the lateral part of the medulla oblongata in the brainstem, and can be caused by occlusion of the vertebral artery on either side 2, 3. However, the most recent and highest quality study on this topic suggests that rotational vertebral artery occlusion can cause symptoms on the contralateral side of the occluded artery, highlighting the importance of considering this condition in patients with vertebrobasilar insufficiency 1. Some key points to consider in the diagnosis and management of vertebral artery occlusion include:
- The use of dynamic subtraction angiography as the diagnostic gold-standard method, but also considering less invasive options such as dynamic Angio-CT scan, Angio-MRI, or Doppler ultrasonography 1
- The importance of identifying the underlying cause of the occlusion, such as atherosclerosis or rotational atlantoaxial instability, in order to guide treatment decisions 4, 1
- The potential for surgical or endovascular treatment options, including posterior C1-C2 arthrodesis or bypass surgery, in patients with symptomatic vertebral artery occlusion 5, 1