title: [Two cases of severe vertigo occasioned by neck rotation and its correlation with the direction of vertebral artery at its origin].
abstract: We report two cases of severe vertigo with neck rotation. The first case is that of a 54-year-old woman. She suffered from severe vertigo during neck rotation to the right. Angiography demonstrated that the origin of the left vertebral artery (VA) became kinked when she turned her head to the right. The second case is that of a 59-year-old man. He suffered from severe vertigo during neck rotation to the left. Angiography demonstrated that the kink in the right VA at its origin became worse with the patient's turning his head to the left. We resected nerve fibers from the stellate ganglion at the origin of the respective vertebral arteries and corrected the kink in the arteries at their origin. Both patients were relieved of vertigo after the operation the fact that there was vertigo occasioned by neck rotation. The direction of neck rotation was identical with that of a kink in the VA at its origin in both patients. Therefore, the direction of neck rotation is useful information for the diagnosis of vertigo induced by neck rotation. In terms of the treatment, though vascular reconstruction such as vein graft bypass between the VA and the carotid artery or transposition of the VA onto the subclavian artery has been established for VA stenosis and occlusion, the resection of nerve fiber from the stellate ganglion at the origin of VA is also effective and safe, especially when a kink in the VA at its origin accompanies with neck rotation.
authors.affiliation: Department of Neurosurgery, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata-city, Yamagata 990-9585, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Kokubo
authors.forename: Takamasa
authors.initials: T
authors.lastname: Kayama
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Ikeda
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000502:physiology*; D009412:Nerve Fibers; D011859:Radiography; D012399:Rotation; D013233:Stellate Ganglion / Q000601:surgery; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000294:innervation; D014715:Vertebrobasilar Insufficiency / Q000209:etiology* / Q000601:surgery; D014717:Vertigo / Q000209:etiology*