From the Guidelines
Right vertebral artery occlusion typically presents with symptoms related to posterior circulation ischemia, including dizziness, vertigo, nausea, vomiting, and imbalance, as well as visual disturbances such as diplopia and cortical blindness, as noted in the 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease 1. The symptoms of right vertebral artery occlusion can be varied and may include:
- Dizziness
- Vertigo
- Nausea
- Vomiting
- Imbalance
- Visual disturbances, such as diplopia (double vision) and cortical blindness
- Dysarthria (slurred speech)
- Dysphagia (difficulty swallowing)
- Ipsilateral facial numbness
- Limb weakness or numbness, often affecting both sides of the body
- Ataxia (lack of coordination)
- Nystagmus (involuntary eye movements) In severe cases, patients may develop altered consciousness, ranging from confusion to coma. The Wallenberg syndrome (lateral medullary syndrome) is a specific presentation that includes vertigo, ipsilateral facial pain/numbness, contralateral body pain/temperature sensory loss, dysphagia, dysarthria, and ipsilateral Horner's syndrome, as described in the guideline 1. These symptoms occur because the vertebral artery supplies critical structures in the brainstem, cerebellum, and occipital lobes. Unlike carotid artery occlusions, vertebral artery occlusions often have fluctuating symptoms due to collateral circulation, making diagnosis challenging, as noted in the guideline 1. It is essential to consider these symptoms in the context of posterior circulation ischemia and to evaluate patients promptly to determine the underlying cause of their symptoms, as recommended in the guideline 1.
From the Research
Symptoms of Right Vertebral Artery Occlusion
The symptoms of right vertebral artery (VA) occlusion can vary, but some common presentations include:
- Sudden unconsciousness and tetraparesis, as seen in a case of an 88-year-old man diagnosed with cerebral infarction resulting from right vertebral artery occlusion 2
- Vertigo, nausea, vomiting, and neck pain, as reported in a case of a 34-year-old man with occlusion of the left vertebral artery secondary to dissection of the left subclavian artery 3
- Dizziness, vertigo, ataxia, dysarthria, dysphagia, progressive or acute paralysis, hemisensory loss, and cervical myelopathy, as described in vertebral artery compression syndrome 4
- Coma, as presented in a case of a 22-year-old woman with a large right cerebellar infarct and occlusion of the distal third of the basilar artery 5
- Bulbar symptoms, positional vertigo, and diplopia, as reported in a case of a 57-year-old man with ectatic vertebral artery associated medullary compression 4
Clinical Presentations
Clinical presentations of vertebral artery occlusion can be diverse and may include:
- Cerebellar infarction, as seen in cases of vertebral artery occlusion 2, 3, 5
- Medullary compression, as reported in a case of ectatic vertebral artery associated medullary compression 4
- Subclavian artery dissection, as described in a case of occlusion of the left vertebral artery secondary to dissection of the left subclavian artery 3