Flanagan CP, Sheth PD, Simons JP. Positional transient loss of consciousness and hemispheric deficits in the setting of severe four-vessel extracranial cerebrovascular disease.
JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019;
5:461-466. [PMID:
31737804 PMCID:
PMC6849350 DOI:
10.1016/j.jvscit.2019.09.001]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/15/2019] [Indexed: 11/23/2022]
Abstract
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.
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