Transcranial sonography and vertebrobasilar insufficiency.
OBJECTIVE
The objective was to discuss a case illustrating the role of transcranial Doppler sonography in the screening and treatment of a patient with intermittent vertebral artery brainstem ischemia.


METHODS
A 28-year-old woman had neck pain, arm pain, headaches, and dizziness. Her symptoms occurred intermittently over several years. Past care had provided little relief. De Kleyn's test, transcranial Doppler sonography, and magnetic resonance imaging/magnetic resonance angiography helped establish a diagnosis of vertebrobasilar syndrome.


RESULTS
The patient was referred for neurosurgical evaluation. She subsequently chose to be treated with spinal manipulative therapy. Her neck pain, headaches, and radicular symptoms resolved. The dizzy spells abated to a tolerable level. The neurosurgeon subsequently re-evaluated the patient and recommended that surgery not be performed.


CONCLUSIONS
This illustrates a case of extra-arterial mechanical compression of the vertebral arteries documented by transcranial Doppler sonography procedures. Brainstem symptoms were correlated with a documented perfusion deficit during cervical positional testing. This case also demonstrated that spinal manipulative therapy may be safely used on patients with vertebrobasilar insufficiency when the biomechanics and related flow studies are elucidated.
Terenzi
Thomas
T
Department of Internal Medicine, Winthrop-University Hospital, Mineola, Long Island, New York 10580, USA.
D000328:Adult; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology