Vertebrobasilar insufficiency during head rotation in thoracic outlet syndrome: A case report

Abstract

Thoracic outlet syndrome leading to vertebrobasilar insufficiency had been reported very rarely. These patients have signs of vertebrobasilar insufficiency when they rotate their heads. It is possible to demonstrate occlusion of vertebral artery with angiography during head rotation. A young man with left sided symptoms of thoracic outlet syndrome had also complained of diplopia when his head had turned to the left side during Adson maneuver. Angiography revealed occlusion of vertebral artery during head rotation. Brain stem auditory evoked potential study performed in both neutral and rotated head position and evidences of brainstem ischemia has been demonstrated during head rotation. The patient reported a complete improvement of his symptoms after surgical therapy. Late post-operative brain stem auditory evoked potential study revealed lack of abnormal findings. These findings led us to emphasize the importance of performing the vertebral angiography while the head rotated; and the possible role of brain stem auditory evoked potential study in evaluation of vertebrobasilar insufficiency and thoracic outlet syndrome cases.