• Journal of Oral Medicine and Pain
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• v.45 no.4
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• pp.97-109
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• 2020

Purpose: Cervicogenic headache (CGH) is pain referred to the head/ face from the structures in vicinity of upper cervical spinal nerves via trigeminocervical pathway. Ponticulus Posticus (PP) and Elongated Styloid Process (ESP) are anatomical structures that cause compression of vasculature present around upper cervical nerve plexus. Recently, computational fluid dynamics (CFD) has shown to play an essential role in identification of these high-pressure zones in the brain. The aim of this research is to study the association of ESP and PP in patients with CGH and to develop a hypothesis by CFD to analyse vertebrobasilar insufficiency as a contributing factor in occurrence of CGH. Methods: Retrospective analysis of 4500 full skull CBCT scans was done for the presence of partial or complete PP and length of Styloid Process (SP). Research was divided into two phases; In first Preliminary Phase, 150 scans that showed the presence of PP and ESP were analysed, and only 134 patients gave consent to fill the questionnaire containing 96 question items pertaining to symptoms associated with CGH. In the second phase, simulation of Vertebral and Carotid Artery was done using Fluent 14.5 Software and by CFD, pressure distribution on arteries was obtained that helped to identify high pressure regions. Results: Both PP and ESP showed a statistically significant association with CGH (p<0.001). By CFD analysis, both steady and transient phases of simulation showed drop in pressure due to constriction of internal carotid and vertebral artery by ESP and PP respectively and were found to decrease the volume of blood reaching the brain, 0.12 /0.13 mL and 0.06 mL respectively. Conclusions: Our analysis proves ESP and PP as contributing factors towards CGH. Hence for proper diagnosis and management of headache disorders, clinicians should have adequate knowledge about these anatomical structures and their resulting clinical symptoms.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.169-173
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• 1990

An aberrant right subclavian artery is a rare congenital anomaly that usually does not produce symptoms. Symptomatic patients require surgical intervention. Ligation of the aberrant artery through a left thoracotomy has been advocated as the operation of choice. If development of vertebrobasilar insufficiency is anticipated, division and ligation of he aberrant artery and its anastomosis to the right common carotid artery or aortic arch are performed at a second operation. Experience with successful surgical treatment of a patient with an aberrant subclavian artery is described. A right thoracotomy incision was utilized for division of the subclavian artery and for reestablishment of arterial continuity with Dacron graft. Postoperative arteriography demonstrated a good reconstruction and normal blood flow was established to the right upper extremity.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.17 no.2
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• pp.106-111
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• 2004

Vertigo is a symptom, not a disease. The tenn vertigo refers to the sensation of spinning or whirling that occurs as a result of a disturbance in balance. It's sometimes referred to as a hallucination of motion. The cause of vertigo is very various and generally divided into peripheral and central. A patient presented with severe vertigo, nystagmus and heteophoria. She has taken the BanHaBaekChulChunMa-tang and treated by acupuncture. After 2 days, her symptoms become disappeared and about 1 week, all symptoms except heterophoria were disapperaed. And after 2 weeks, heterophoria was disappeared. In conclusion, we diagnosed her case as vestbular neuronitis by her clinical course, but we also considered her illness as vertebrobasilar insufficiency, TIA etc.

• Journal of Korean Neurosurgical Society
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• v.65 no.4
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• pp.603-608
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• 2022

Vertebral artery (VA) occlusion is frequently encountered, usually without acute ischemic injury of the brain. However, when it is accompanied by hypoplasia or stenosis of the opposite VA, brain ischemia may develop due to insufficient collateral supply. Both hemodynamic instability and embolic infarction can occur in VA occlusion, which may cause severe symptoms in a patient. Extracranial carotid-VA bypass should be considered for symptomatic VA occlusion patients, especially when the patient has repeated ischemic brain injuries. In this report, the cases of three extracranial carotid-VA bypass patients are introduced, along with a brief description of the surgical techniques. All three cases were treated with different bypass methods according to their disease location.

• Journal of Trauma and Injury
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• v.29 no.1
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• pp.28-32
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• 2016

Blunt traumatic vertebral artery injury (TVAI) is relatively rare, but it may frequently be associated with head and neck trauma. TVAI is difficult to diagnose with diverse outcomes, thus it is a clinical challenge. There are no widely accepted guidelines for treatment and diagnosis, so that the diagnosis of TVAI can be easily delayed. Therefore, any clinical suspicion from clues on the initial imaging is important for diagnosis of TVAI. The authors report on the case of a patient diagnosed as having a TVAI with a transverse foramen fracture.

• Annals of Clinical Neurophysiology
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• v.9 no.1
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• pp.1-4
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• 2007

Vertigo is an illusion of rotation, which results from an imbalance within the vestibular system. This review focuses on two common presentations of spontaneous vertigo: acute prolonged spontaneous vertigo and recurrent spontaneous vertigo. Common causes of acute prolonged spontaneous vertigo include vestibular neuritis, labyrinthitis, and brainstem or cerebellar stroke. The history and detailed neurological/neurotological examinations usually provide the key information for distinguishing between peripheral and central causes of vertigo. Brain MRI is indicated in any patient with acute vertigo accompanied by abnormal neurological signs, profound imbalance, severe headache, and central patterns of nystagmus. Recurrent spontaneous vertigo occurs when there is a sudden, temporary, and largely reversible impairment of resting neural activity of one labyrinth or its central connections, with subsequent recovery to normal or near-normal function. Meniere's disease, migrainous vertigo, and vertebrobasilar insufficiency (VBI) are common causes. The duration of the vertigo attack is a key piece of information in recurrent spontaneous vertigo. Vertigo of vascular origin, such as VBI, typically lasts for several minutes, whereas recurrent vertigo due to peripheral inner-ear abnormalities lasts for hours. Screening neurotological evaluations, and blood tests for autoimmune and otosyphilis are useful in assessment of recurrent spontaneous vertigo that are likely to be peripheral in origin.

• The Journal of Internal Korean Medicine
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• v.41 no.2
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• pp.267-274
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• 2020

Objectives: This study is aimed to describe the effects of using a traditional Korean herbal medicine, Jaeumkunbi-tang, on acute dizziness and gait disturbance that arose during treatment for trigeminal neuralgia. Methods: We closely observed one female patient who had been hospitalized complaining of trigeminal neuralgia and acute onset of dizziness. The patient was treated using Korean medical treatments, such as Oyaksungi-san, Jaeumkunbi-tang, acupuncture, and moxibustion. We evaluated the patient's condition using the visual analog scale (VAS) at the Department of Hepato-Hemopoietic System, Kyung Hee University Korean Medicine Hospital in June 2019 for 12 days. Results: The patient's dizziness was decreased after treating with Jaeumkunbi-tang for five days as measured by the VAS score. Conclusions: Jaeumkunbi-tang appears to be effective for controlling dizziness.

• Journal of the Korean Society of Radiology
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• v.82 no.5
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• pp.1281-1286
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• 2021

Brainstem infarction due to vertebrobasilar insufficiency is a rare initial presentation of systemic lupus erythematosus (SLE) patients and small-vessel dissection as the direct cause of infarction has not been reported. We report the case of a 20-year-old female with acute infarction on the right side of the pons due to a small artery (pontine perforator) dissection, identified on digital subtraction angiography and high-resolution vessel wall MRI (vwMRI). She was diagnosed with SLE based on the presence of neurologic disorders and relevant laboratory findings. The pontine perforator-dissecting aneurysm had occluded and the right distal vertebral artery had resolved on subsequent vwMRI. She had a modified Rankin Scale (mRS) score of 1 at discharge with mild symptom improvement, and exhibited no further aggravation of symptoms at 3 or 12 months, maintaining an mRS score of 1.