Vertebral artery tortuosity spasm

Introduction Traumatic embolism of vertebral artery is a serious complication of neck contusion. Due to changes in the position of the cervical vertebrae, the vertebral artery is distorted, paralyzed, and compressed, and transient symptoms appear. Secondary thrombosis can also result from intense traction or tearing of the vertebral artery. The vertebral artery is one of the main blood supply arteries of the brain tissue, and a series of neurological symptoms often appear after embolization. Head traction, braking and anticoagulation measures must be taken in a timely manner.

Cause

(1) Causes of the disease:

Many traumas of the head and neck can lead to traumatic embolization of the vertebral artery, such as neck contusion, cervical spine fracture and dislocation, cervical vertebrae due to ligament rupture and dislocation to compress the vertebral artery. The head and neck can be damaged by excessive force and can also damage the vertebral artery. When the cervical vertebra disease is repaired, the rude motion also damages the vertebral artery.

(2) Pathogenesis:

The site of traumatic embolization of the vertebral artery is different, and the damage is also different.

1. Cervical transverse process hole segment: After the vertebral artery is separated from the innominate artery, it enters the transverse cervical process of the cervical vertebra above the sixth cervical vertebra and rises vertically, which is closely related to the cervical vertebrae. When the cervical spine is fractured and dislocated, the vertebral artery is susceptible to distortion and compression and embolism. The vessel wall is damaged or the intima of the blood vessel is torn, thereby forming a thrombus, which progresses retrogradely.

2. The transitional section of the atlantoaxial joint: the vertebral artery leaves the transverse process of the cervical vertebrae at the atlantoaxial joint, and turns from vertical to horizontal, and follows the posterior arch of the atlas to advance inward and forward. When congenital odontoids are not connected, or in the pathological conditions of neck infection, cervical decalcification, and neck ligament relaxation, atlantoaxial dislocation is highly prone to neck contusion. The occipital epiphysis slips forward and can compress the vertebral artery and cause occlusion. The vertebral artery is directly wrapped between the oblique and intertransverse muscles between the atlanto-axial and the lateral vertebral foramen. When the head injury is severely rotated, the vertebral artery can be pressed by any muscle. .

3. Vertebral artery occipital large hole segment: The vertebral artery enters the skull through the tough occipital membrane and dura mater at the occipital foramen. When the head is over-rear, the two membranes can compress the vertebral artery.

The internal carotid artery and the vertebral artery are the main sources of cerebral arteries. The branches of the two arteries are mutually anastomosed to form the cerebral artery ring, also known as the Willis ring.

In normal people, the bilateral vertebral arteries have a collateral circulation through the posterior communicating artery (the internal carotid artery branch). When one side of the vertebral artery is compressed or embolized, blood supply can be obtained from the other side of the vertebral artery. If arteriosclerosis or cervical vertebra hyperplasia oppresses blood vessels, the compensatory function of the above collateral circulation is affected, and vertebral artery occlusion is prone to occur after contusion. If there is vascular malformation or heavier arteriosclerosis, or only one side of the vertebral artery supplies basilar artery blood flow, the blood supply to the Willis ring is prone to occur after contusion of the vertebral artery. Normal vertebral artery unequal is more than 70%, if the thicker vertebral artery has embolism, prone to symptoms. In addition, if the cervical vertebrae have been compressed by the cervical vertebrae, the basilar artery has thrombosis, or has severe atherosclerotic lesions, the head is excessively rotated to one side when injured, enough to cause the basilar artery blood flow to be interrupted and cause sudden death.

The vertebral artery traumatic ischemic symptoms can be transient or progressive. Due to changes in the position of the cervical vertebrae, the vertebral artery is distorted, paralyzed, and compressed, and transient symptoms appear. After the compression factor is removed, the ischemic symptoms can disappear. If the vertebral artery is strongly pulled or torn, it can cause secondary thrombosis and can extend upward to the basilar artery. Ischemic symptoms can occur in a few hours to several days after compression and progress progressively.

The main branch of the vertebral artery after entering the cranium is the posterior inferior cerebellar artery and the anterior spinal artery. Then the bilateral vertebral artery is synthesized into the basilar artery. Therefore, the main clinical manifestations are brain stem, cerebellum and cervical spinal cord ischemia. That is, signs of posterior inferior cerebellar artery syndrome and brainstem lesions, such as dizziness, ataxia, difficulty swallowing, facial numbness, nerves and tongue. Basilar artery embolism can occur in ocular dyskinesia, facial paralysis, hemiplegia, quadriplegia and coma. The anterior spinal artery embolism syndrome is mainly quadriplegia, and the upper limb is heavier than the lower limb with mild sensory disturbance. The recovery process of quadriplegia is the first lower limb, the upper upper limb, and the function recovery of the hand is often slower.

an examination

Related inspection

Brain CT examination of brain ultrasound

1. History: There is a history of recent neck contusion or external force on the neck.

2. Clinical manifestations: With or without cervical spine fracture or dislocation, as long as there is brain stem ischemia or cervical spinal cord ischemia symptoms, and neurological examination shows cerebellar and brain stem lesions, it should be highly alert to vertebral artery injury.

3. Auxiliary examination and diagnosis.

Differential diagnosis

1. Acute brain injury: signs of encephalopathy generally appear earlier. A diagnosis can be established from the history of trauma and the signs of head trauma. The posterior inferior cerebellar artery syndrome and brain stem symptoms of vertebral artery injury generally appear slower. Sudden death from an injury to an acute vertebral artery blood supply disorder, often with an intermediate awake period.

2. Acute cervical spinal cord injury: quadriplegia occurs rapidly, with severe degree, long-stem symptoms of the spinal cord are relatively obvious, and the recovery process of symptoms is also very slow. Quadriplegia caused by vertebral artery embolism, upper limbs are heavier than lower limbs, accompanied by mild or no long-sense sensory symptoms, and the recovery process is faster. However, if the cervical spinal cord ischemia time is too long after injury, the spinal cord damage is heavier and irreversible.

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