Vertebral artery dissection can cause the rotational vertebral artery syndrome.

초록

background & Significance : Rotational vertebral artery syndrome (RVAS) is characterized by recurrent attacks of vertigo, nystagmus, ataxia, or tinnitus which are elicited by head rotation. The pathomechanism of RVAS is presumed as transient compression of the dominant vertebral artery (VA) by the rotational head movement. We report two patients with vertebral artery dissection, who had the vertigo and nystagmus during head rotation. Case : A 47-year-old woman and a 59-year-old woman complained of the sudden occurrence of recurrent paroxysmal vertigo by head rotation and these symptoms were persistent over 3 months. On neurologic examination, the nystagmus was evoked by head rotation in two patients. Routine magnetic resonance images and angiography(MRI/A) revealed no abnormal lesions. The mean flow velocity in unilateral vertebral artery during head-turning, compared to neutral position was reduced by over 35% on trans-cranial doppler sonography. The conventional angiography showed the vertebral artery dissection in both cases. After the oral anticoagulation, the nystagmus and vertigo related to head turning disappeared. Conclusions or Comments : The vertebral artery dissection can also cause the RVAS, despite of absence of lesions on the rountine MRI/A.