Vertebro-Basilar insufficency

66 year old woman status post numerous cervical spinal surgeries develops new "dizziness" after three months of most recent cervical spine surgical procedure. She describes that three months after the surgery she developed "dizziness" with rotation of the head to the left or with extension of the neck. Neck extension causes the most severe symptoms. She notes that when she puts her head back she feels "lightheaded" like she is going to pass out or go to sleep. There is no illusion of movement, or vestibular dysfunction. The spells are easily reproducible and on examination during a spell her pulse and blood pressure is normal, she has no nystgamus she just feels very "light headed". Of note she is known to have a chronic left vertebral occlusion and a normal right vertebral artery.


Here is angiography before neck extension (top) and after neck extension (bottom). True vertebro-basilar insufficiency is rare but does happen with bilateral vertebral artery compression or unilateral compression with occluded or congenitally atretic contralateral vertebral artery. Of interest this patient denied vertigo during spells, probably as she was hypoperfusing the entire reticular activating system with neck extension.