Reproducible Presyncope Due to Osteophyte Compression Into Transverse Foramen of the C5 Vertebra

Yuya Kano, Kentaro Yamada, Masahiro Muto, Masahiro Oomura, Noriyuki Matsukawa
Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association 2021 January 18, 30 (4): 105562
Beauty parlor stroke syndrome is characterized by the development of various neurological symptoms during cervical hyperextension, followed by inadequate blood flow through the posterior circulation of the brain. However, there are few reports of beauty parlor stroke syndrome wherein the cause of the posterior circulatory inadequacy has been directly identified. Here we report a case where we could directly detect the origin of the posterior circulatory inadequacy. A 76-year-old Japanese man with hypertension presented with presyncope following cervical retroflexion. Head magnetic resonance angiography revealed that the vertebrobasilar circulation was exclusively supplied by the right vertebral artery. Cervical spine computed tomography showed compression of the osteophytes on the right superior articular process of C6 into the right transverse foramen of C5. Moreover, computed tomography angiography and carotid duplex ultrasonography showed decreased blood flow in the right vertebral artery on gradual retroflexion of the neck. Based on the above findings, we speculate that the right vertebral artery was compressed by the osteophytes, with the decreased blood flow being the cause of presyncope following cervical retroflexion.

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