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NEUROIMAGE
Year : 2014  |  Volume : 62  |  Issue : 4  |  Page : 479-480

Retrograde thromboembolic vertebrobasilar artery infarct due to right cervical rib


1 Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
3 Department of Neurology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India

Date of Web Publication19-Sep-2014

Correspondence Address:
Vimal Kumar Paliwal
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences,Raebareli Road, Lucknow - 226 014, Uttar Pradesh
India
Vimal Kumar Paliwal
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences,Raebareli Road, Lucknow - 226 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.141310

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How to cite this article:
Kinge NG, Paliwal VK, Neyaz Z, Sharma R, Kinge NG, Paliwal VK, Neyaz Z, Sharma R. Retrograde thromboembolic vertebrobasilar artery infarct due to right cervical rib. Neurol India 2014;62:479-80

How to cite this URL:
Kinge NG, Paliwal VK, Neyaz Z, Sharma R, Kinge NG, Paliwal VK, Neyaz Z, Sharma R. Retrograde thromboembolic vertebrobasilar artery infarct due to right cervical rib. Neurol India [serial online] 2014 [cited 2020 Oct 20];62:479-80. Available from: https://www.neurologyindia.com/text.asp?2014/62/4/479/141310


A 20-year-male, right-handed, construction-site laborer presented with acute vertigo, vomiting, followed by weakness of all four limbs, and unconsciousness of 8 days duration. On examination, right radial/brachial arteries pulses were not palpable. Left arm blood pressure was 120/70 mm of Hg and pulse rate 60/min, regular with normal palpable femoral/popliteal/dorsalispedis arteries. Neurological examination revealed patient in complete locked-in state, with spasticity with brisk deep-tendon jerks along with extensor planter. Cranial magnetic resonance imaging (MRI) revealed acute infarct involving pons, left inferior cerebellar peduncle, and left occipital cortex. MR-angiography revealed non-visualized basilar artery and intracranial part of left vertebral artery. Volume-rendered computed tomography (CT) images showed right cervical rib causing irregular narrowing of the right subclavian artery with post-stenotic dilatation and thrombosis of the right axillary artery. Color Doppler showed no blood flow in the right subclavian artery on over-head right arm abduction with resumed blood-flow on arm adduction [Figure 1]. Patient's electrocardiogram, 2D Echo, and immunological and thrombophilic profiles were normal.

Cervical rib is responsible for less than 1% of ischemic stroke. [1] It seldom produces left internal carotid artery stroke due to origin of left common carotid from aorta. However, unlike our patient, vertibrobasilar strokes are mostly seen in relation to left cervical rib. [2] Preceding neural/vascular features of thoracic outlet syndrome are common in the majority. Retrograde flow in the subclavian artery during diastole possibly produces retrograde propagation of thrombus into carotids and vertebral artery. [3] Repeated over-head arm abduction as per work profile of our patient might have contributed to right subclavian artery thrombosis.
Figure 1: (a) Cranial MRI (FLAIR) shows pontine infarct. (b) MR angiography shows non-visualized basilar/left vertebral artery. (c) Volume-rendered CT shows right cervical rib compressing adjacent subclavian artery. (d and e) Color Doppler shows cessation of flow in distal subclavian artery with arm abduction

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  References Top

1.Awada A. Stroke in Saudi Arabian young adults: A study of 120 cases. Acta Neurol Scand 1994;89:323-8.  Back to cited text no. 1
[PUBMED]    
2.Sharma S, Kumar S, Joseph L, Singhal V. Cervical rib with stroke as the initial presentation. Neurol India 2010;58:645-7.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Gooneratne IK, Gamage R, Gunarathne KS. Pearls and oy-sters: Distal subclavian artery: A source of cerebral embolism. Neurology 2009;73:e11-2.  Back to cited text no. 3
    


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