Positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular disease

Positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular disease

Carotid artery stenosis typically causes hemispheric neurologic effects by atheroembolism. Nonhemispheric symptoms, such as syncope, are generally not attributable to extracranial carotid disease. This report describes a 62-year-old woman with severe bilateral carotid artery stenosis, right vertebra...

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Main Authors: Colleen P. Flanagan, BA, Parth D. Sheth, MD, Jessica P. Simons, MD, MPH
Format: Article
Language:English
Published: Elsevier 2019-12-01
Series:Journal of Vascular Surgery Cases and Innovative Techniques
Online Access:http://www.sciencedirect.com/science/article/pii/S2468428719301182
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spelling doaj-b21537e33a7244ed99164153bc3cbda82020-11-25T00:16:07ZengElsevierJournal of Vascular Surgery Cases and Innovative Techniques2468-42872019-12-0154461466Positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular diseaseColleen P. Flanagan, BA0Parth D. Sheth, MD1Jessica P. Simons, MD, MPH2Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MassDivision of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MassCorrespondence: Jessica P. Simons, MD, MPH, Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, 55 Lake Ave N, Worcester, MA 01655; Division of Vascular and Endovascular Surgery, University of Massachusetts Medical School, Worcester, MassCarotid artery stenosis typically causes hemispheric neurologic effects by atheroembolism. Nonhemispheric symptoms, such as syncope, are generally not attributable to extracranial carotid disease. This report describes a 62-year-old woman with severe bilateral carotid artery stenosis, right vertebral artery occlusion, and severe left vertebral artery stenosis who presented with transient loss of consciousness and unilateral weakness when upright. Her symptoms resolved after right carotid endarterectomy. Whereas vertebrobasilar insufficiency alone can cause syncope, in the case of severe multivessel cerebrovascular disease, unilateral carotid revascularization was successful in treating the patient's transient loss of consciousness, suggesting global cerebral hypoperfusion as the cause. Keywords: Carotid stenosis, Vertebrobasilar, Hypoperfusion, Positionalhttp://www.sciencedirect.com/science/article/pii/S2468428719301182
collection DOAJ
language English
format Article
sources DOAJ
author Colleen P. Flanagan, BA
Parth D. Sheth, MD
Jessica P. Simons, MD, MPH
spellingShingle Colleen P. Flanagan, BA
Parth D. Sheth, MD
Jessica P. Simons, MD, MPH
Positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular disease
Journal of Vascular Surgery Cases and Innovative Techniques
author_facet Colleen P. Flanagan, BA
Parth D. Sheth, MD
Jessica P. Simons, MD, MPH
author_sort Colleen P. Flanagan, BA
title Positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular disease
title_short Positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular disease
title_full Positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular disease
title_fullStr Positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular disease
title_full_unstemmed Positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular disease
title_sort positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular disease
publisher Elsevier
series Journal of Vascular Surgery Cases and Innovative Techniques
issn 2468-4287
publishDate 2019-12-01
description Carotid artery stenosis typically causes hemispheric neurologic effects by atheroembolism. Nonhemispheric symptoms, such as syncope, are generally not attributable to extracranial carotid disease. This report describes a 62-year-old woman with severe bilateral carotid artery stenosis, right vertebral artery occlusion, and severe left vertebral artery stenosis who presented with transient loss of consciousness and unilateral weakness when upright. Her symptoms resolved after right carotid endarterectomy. Whereas vertebrobasilar insufficiency alone can cause syncope, in the case of severe multivessel cerebrovascular disease, unilateral carotid revascularization was successful in treating the patient's transient loss of consciousness, suggesting global cerebral hypoperfusion as the cause. Keywords: Carotid stenosis, Vertebrobasilar, Hypoperfusion, Positional
url http://www.sciencedirect.com/science/article/pii/S2468428719301182
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AT jessicapsimonsmdmph positionaltransientlossofconsciousnessandhemisphericdeficitsinthesettingofseverefourvesselextracranialcerebrovasculardisease
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