An 83-year-old woman presented sudden vertigo, drop attack, and transient dysarthria after head hyperextension to see the Sistine Chapel ceiling, in the Vatican. Transcranial doppler ultrasound (Figure 1) suggested proximal basilar stenosis, confirmed by arteriography (Figure 2). Case 2: A 77-year-old woman presented a 1-year history of transient vertigo after hanging clothes on a clothesline. Transcranial doppler ultrasound (Figure 3) revealed left subclavian artery steal phenomenon secondary to proximal subclavian artery stenosis, confirmed by arteriography (Figure 4). They received stenting and dual antiplatelet therapy. Transient ischemic symptomatology triggered by head/neck and arm movements demands vertebrobasilar and subclavian evaluation.11 Go JA, Al Othman B, Kini A, Beaver HA, Lee AG. Vertebrobasilar ischemia (VBI) related neuro-ophthalmic syndromes after routine activities involving hyperextension or rotation of the neck (hairdresser syndrome). Eye (Lond) 2020;34(05):901–905–33 Kargiotis O, Siahos S, Safouris A, Feleskouras A, Magoufis G, Tsivgoulis G. Subclavian steal syndrome with or without arterial stenosis: A review. J Neuroimaging 2016;26(05):473–480
Transcranial Doppler show signs of segmental increase in flow velocity in the proximal basilar artery, compatible with basilar artery stenosis.
Brain arteriography showing severe stenosis in the proximal basilar artery (A). Postangioplasty control with stent in the proximal basilar artery (B).
References
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1Go JA, Al Othman B, Kini A, Beaver HA, Lee AG. Vertebrobasilar ischemia (VBI) related neuro-ophthalmic syndromes after routine activities involving hyperextension or rotation of the neck (hairdresser syndrome). Eye (Lond) 2020;34(05):901–905
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2Savitz SI, Caplan LR. Vertebrobasilar disease. N Engl J Med 2005;352(25):2618–2626
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3Kargiotis O, Siahos S, Safouris A, Feleskouras A, Magoufis G, Tsivgoulis G. Subclavian steal syndrome with or without arterial stenosis: A review. J Neuroimaging 2016;26(05):473–480
Publication Dates
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Publication in this collection
28 Apr 2023 -
Date of issue
2022
History
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Received
08 May 2022 -
Accepted
15 June 2022