Vertebral artery loop causing cervical radiculopathy

We report on a 68-year-old woman with an abnormal loop of the extracranial VA enlarging the intervertebral foramen at C4-5 and compressing the C5 root causing radiculopathy. The diagnosis was confirmed on contrast enhanced CT and MR angiography after initial conservative treatment was unsuccessful. Microvascular decompression using an anterior approach was curative.     

Vertebral artery dissection due to a bone anomaly of the superior facet of C6: a rare cause of embolic stroke

We report a rare case of repeated vertebral artery (VA) occlusion. The VA occlusion was due to a distal embolism originating from traumatic VA dissection resulting from mechanical compression due to excessive bone formation of the superior facet of C6. A 39-year-old male suffered from two embolic events in the right VA with a 4-month intervals. Three-dimensional computed tomography (3D-CT) revealed abnormal bone of the superior facet at the level of C6 and the verterbral artery compression. Angiography demonstrated the irregularity and the late clearance of the contrast material at the stenosis of VA, which was diagnosed as the dissection. Dynamic angiography showed right VA occlusion when rotating the patients head to the left and extending it backwards. External orthosis using a cervical collar for 1 month was undertaken, but the dissection remained, so coil embolization of the right VA was performed using an intravascular procedure. Because of the age of the patient, location, radiological features and clinical course, the authors considered the excessive bone formation was a bone anomaly rather than a cervical spondylotic change.     

Gluteal artery pseudoaneurysm,a rare cause of sciatic pain: case report and literature review

This article describes a very unusual case of sciatic pain and motor dysfunction resulting from gluteal artery pseudoaneurysm. A 36-year-old woman with primary infertility sustained an iatrogenic injury to her left gluteal artery during transvaginal ultrasound-guided follicle aspiration. Twenty-five days after the procedure she developed severe left sciatic pain and motor dysfunction. Pelvic computed tomography and magnetic resonance imaging revealed a huge pelvic hematoma. Angiography demonstrated a gluteal artery pseudoaneurysm. Because endovascular occlusion of the aneurysm did not relieve the pain, the patient underwent surgery for evacuation of the hematoma and release of the lumbosacral plexus. This eliminated all her sciatic pain and restored her motor dysfunction completely. The English literature details only five other cases of sciatic pain resulting from gluteal artery aneurysm, and these reports are also discussed.     

The immediate effects of a cervical lateral glide treatment technique in patients with neurogenic cervicobrachial pain

STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To analyze the immediate treatment effects of cervical mobilization and therapeutic ultrasound in patients with neurogenic cervicobrachial pain. BACKGROUND: Different treatment modalities have been described for patients with neurogenic cervicobrachial pain. Although it has been suggested that a more specific approach, like cervical mobilization, would be more effective, effect studies are scarce. METHODS AND MEASURES: Twenty patients with subacute peripheral neurogenic cervicobrachial pain were assessed. Besides other criteria, patients were included if a cervical segmental motion restriction was present which could be regarded as a possible cause of the neurogenic disorder. Patients were randomly assigned to a mobilization or ultrasound group. Mobilization consisted of a contralateral lateral glide technique. The range of elbow extension, symptom distribution, and pain intensity during the neural tissue provocation test for the median nerve were used as outcome measures. Results were analyzed using a 2-way mixed-design ANOVA. RESULTS: Significant differences in treatment effects between the 2 groups could be observed for all outcome measures (P < or = .0306). For the mobilization group, the increase in elbow extension from 137.3 degrees to 156.7 degrees, the 43.4% decrease in area of symptom distribution, and the decreased pain intensity from 7.3 to 5.8 were significant (P < or = .0003). For the ultrasound group, there were no significant improvements (P > or = .0521). CONCLUSIONS: When a cervical dysfunction can be regarded as a cause of the neurogenic disorder or as a contributing factor that impedes natural recovery, a cervical lateral glide mobilization has positive immediate effects in patients with subacute peripheral neurogenic cervicobrachial pain. This movement-based approach seems preferable to ultrasound.