Reverse Flow Thromboembolism From Distal Subclavian Artery Aneurysm Due to Arterial Thoracic Outlet Syndrome and Posterior Circulation Stroke-Role of Dynamic Doppler Imaging.

IF 1.1 4区 医学 Q4 CLINICAL NEUROLOGY Neurologist Pub Date : 2024-07-01 DOI:10.1097/NRL.0000000000000536
Adarsh Anil Kumar, Santhosh Kumar Kannath, Bejoy Thomas, Sylaja Pn, Shivanesan P, Manju Surendran
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Abstract

Introduction: Arterial thoracic outlet syndrome (aTOS) is the least common among the 3 subtypes of thoracic outlet syndrome and can be the cause of posterior circulation infarction due to thrombus from a secondary thrombosed subclavian-axillary artery aneurysm.

Case report: Here, we report a case of a 51-year-old man who presented to our institute with sudden onset vertigo, dizziness, vomiting, gait imbalance, and visual field defects immediately after strenuous exercise. Computed tomography angiography revealed bilateral cervical ribs with aneurysmal dilatation of the left distal subclavian and proximal axillary arteries. The computed tomography also revealed subacute infarcts in the bilateral cerebellar hemispheres, as well as in the bilateral occipital lobes. Color Doppler evaluation of the subclavian artery after hyperabduction of the ipsilateral arm revealed a continuous reversal of flow in the subclavian artery, which reached the vertebral ostia. The left cervical rib was resected, aneurysm was repaired, and the patient remained asymptomatic on follow-up.

Conclusion: Posterior circulation stroke caused by the ipsilateral thrombosed subclavian artery aneurysm in an adult patient with aTOS due to a complete cervical rib is rare. A high index of suspicion should be present for thoracic outlet syndrome in patients with stroke and upper-limb arterial claudication symptoms. Dynamic Doppler evaluation in such patients can be used to demonstrate the underlying pathomechanism, and definitive surgical treatment can prevent further ischemic episodes. Posterior circulation stroke caused by partially thrombosed distal subclavian and axillary artery aneurysms due to aTOS is rare.

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由于胸动脉出口综合征和后循环卒中引起的锁骨下动脉远端动脉瘤的逆流血栓栓塞——动态多普勒成像的作用。
引言:胸廓动脉出口综合征(aTOS)是胸廓出口综合征的三种亚型中最不常见的,可能是由继发性血栓性锁骨下腋动脉瘤血栓引起的后循环梗死的原因。病例报告:我们报告一例51岁的男性患者,他在剧烈运动后立即出现眩晕、头晕、呕吐、步态失衡和视野缺陷。计算机断层扫描血管造影术显示双侧颈肋,左锁骨下动脉远端和腋下动脉近端动脉瘤样扩张。计算机断层扫描还显示双侧小脑半球和双侧枕叶有亚急性梗死。同侧臂过度收缩后对锁骨下动脉的彩色多普勒评估显示,锁骨下动脉血流持续逆转,到达椎口。切除了左侧颈肋,修复了动脉瘤,患者在随访中仍然没有症状。结论:在一名因颈肋完整而患有aTOS的成年患者中,由同侧血栓性锁骨下动脉瘤引起的后循环卒中是罕见的。对于有中风和上肢动脉跛行症状的患者,应高度怀疑胸廓出口综合征。对这类患者的动态多普勒评估可以用来证明潜在的病理机制,明确的手术治疗可以防止进一步的缺血性发作。由aTOS引起的锁骨下动脉和腋动脉远端部分血栓形成的动脉瘤引起的后循环卒中是罕见的。
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来源期刊
Neurologist
Neurologist 医学-临床神经学
CiteScore
1.90
自引率
0.00%
发文量
151
审稿时长
2 months
期刊介绍: The Neurologist publishes articles on topics of current interest to physicians treating patients with neurological diseases. The core of the journal is review articles focusing on clinically relevant issues. The journal also publishes case reports or case series which review the literature and put observations in perspective, as well as letters to the editor. Special features include the popular "10 Most Commonly Asked Questions" and the "Patient and Family Fact Sheet," a handy tear-out page that can be copied to hand out to patients and their caregivers.
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