title: Rotational vertebral artery occlusion: mechanisms and long-term outcome.
abstract: OBJECTIVE
  To elucidate the mechanisms and prognosis of rotational vertebral artery occlusion (RVAO).
  
  
  METHODS
  We analyzed clinical and radiological characteristics, patterns of induced nystagmus, and outcome in 21 patients (13 men, aged 29-77 years) with RVAO documented by dynamic cerebral angiography during an 8-year period at 3 University Hospitals in Korea. The follow-up periods ranged from 5 to 91 months (median, 37.5 months). Most patients (n=19; 90.5%) received conservative treatments.
  
  
  RESULTS
  All the patients developed vertigo accompanied by tinnitus (38%), fainting (24%), or blurred vision (19%). Only 12 (57.1%) patients showed the typical pattern of RVAO during dynamic cerebral angiography, a compression of the dominant vertebral artery at the C1-2 level during contralateral head rotation. The induced nystagmus was mostly downbeat with horizontal and torsional components beating toward the compressed vertebral artery side. None of the patients with conservative treatments developed posterior circulation stroke, and 4 of them (21.1%) showed resolution of symptoms during the follow-ups.
  
  
  CONCLUSIONS
  RVAO has various patterns of vertebral artery compression, and favorable long-term outcome with conservative treatments. In most patients with RVAO, the symptoms may be ascribed to asymmetrical excitation of the bilateral labyrinth induced by transient ischemia or by disinhibition from inferior cerebellar hypoperfusion. Conservative management might be considered as the first-line treatment of RVAO.
authors.affiliation: Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea.
authors.forename: Kwang-Dong
authors.initials: KD
authors.lastname: Choi
authors.forename: Jae-Hwan
authors.initials: JH
authors.lastname: Choi
authors.forename: Ji-Soo
authors.initials: JS
authors.lastname: Kim
authors.forename: Hyo Jung
authors.initials: HJ
authors.lastname: Kim
authors.forename: Min-Ji
authors.initials: MJ
authors.lastname: Kim
authors.forename: Tae-Hong
authors.initials: TH
authors.lastname: Lee
authors.forename: Hyung
authors.initials: H
authors.lastname: Lee
authors.forename: In Soo
authors.initials: IS
authors.lastname: Moon
authors.forename: Hui Jong
authors.initials: HJ
authors.lastname: Oh
authors.forename: Jae-Il
authors.initials: JI
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000209:etiology; D011379:Prognosis; D011859:Radiography; D056910:Republic of Korea; D012399:Rotation / Q000009:adverse effects*; D013997:Time Factors; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*
keywords: mechanism; prognosis; rotational vertebral artery occlusion; stroke