RETROGRADE CEREBRAL EMBOLISM

doi:10.1016/S0140-6736(79)92443-7

The Lancet

Volume 314, Issue 8151, 17 November 1979, Pages 1044-1047

https://doi.org/10.1016/S0140-6736(79)92443-7 Get rights and content

Abstract

Cerebral embolism may complicate lesions of the subclavian arteries or aortic isthmus distal to the origins of the vertebral or carotid arteries. This may be due to retrograde propagation of occlusive thrombus. In other cases the vessels are patent but there are periods of reverse blood flow, creating a potential for reflux of embolic material to the ostia of the neck vessels.

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Cited by (33)

Bilateral cervical ribs causing cerebellar stroke and arterial thoracic outlet syndrome: A case report and review of the literature
2015, Annals of Vascular Surgery
Stroke is an exceedingly rare presentation of arterial thoracic outlet syndrome (aTOS). This report describes a case of cerebellar stroke secondary to aTOS and reviews the literature. A 56-year-old woman with no previous history of stroke or arm ischemia presented with vertigo. Computed tomography (CT) and magnetic resonance imaging confirmed a left cerebellar ischemic stroke. She subsequently developed ischemia of her left arm, which was treated by a thromboembolectomy. CT angiography revealed bilateral cervical ribs along with bilateral subclavian artery aneurysms. Staged resection of the cervical ribs and reconstruction of the subclavian arteries were performed. Symptomatic arterial thoracic outlet syndrome most commonly presents as arm ischemia because of embolization of intramural clot from a subclavian artery aneurysm or because of thrombosis of the subclavian artery aneurysm itself. In rare cases, the clot can propagate retrograde, resulting in stroke. In young patients presenting with ischemic stroke, arterial thoracic outlet syndrome should be considered as part of the differential diagnosis.
Atypical thoracic outlet syndrome and reverse flow thromboembolism
2014, Pediatric Neurology
Citation Excerpt :
The vascular anatomy of the left subclavian artery differs in that the carotid artery originates directly from the aortic arch so a vertebrobasilar embolus is far more likely.8 It may be that patient 3 from the series by Prior et al. experienced this as the pathology was left sided and the symptoms consisted of vertigo and lightheadedness, which may be associated with vertebrobasilar ischemia.7 Both our patients experienced transient symptoms consistent with posterior circulation ischemia, and both improved after left-sided thoracic outlet decompression.
Thoracic outlet syndrome is rare in children but may have serious consequences. Compression of the neurovascular structures at the thoracic outlet by anomalous soft tissues or cervical ribs may cause neurological deficits in the upper limb and venous or arterial insufficiency.
The symptoms and signs of this condition are well documented, but we describe two patients with an atypical presentation. We review similar published cases where delay in diagnosis resulted in cerebrovascular catastrophe. Our patients presented with relatively nonspecific central nervous system symptoms and were found to have thoracic outlet compression. Both were treated by surgical decompression of the thoracic outlet, and the symptoms completely resolved with no long-lasting neurological consequences.
We highlight the importance of these rare cases because of the risk of stroke and discuss the theory behind the pathological process.
Thromboembolic stroke associated with thoracic outlet syndrome
2014, Journal of Clinical Neuroscience
Citation Excerpt :
Right-sided SCA disease was present in all patients except one, reflecting that the innominate artery gives rise to the subclavian and common carotid arteries on the right side. One case of posterior circulation infarction was associated with left SCA occlusion [8]. Seventeen (65%) patients underwent thoracic outlet decompression via rib resection, usually via a supraclavicular approach.
Thoracic outlet syndrome occurs due to compression of the neurovascular structures as they exit the thorax. Subclavian arterial compression is usually due to a cervical rib, and is rarely associated with thromboembolic stroke. The mechanism of cerebral embolisation associated with the thoracic outlet syndrome is poorly understood, but may be due to retrograde propagation of thrombus or transient retrograde flow within the subclavian artery exacerbated by arm abduction. We report an illustrative patient and review the clinical features, imaging findings and management of stroke associated with thoracic outlet syndrome.
Cervical rib resulting in amaurosis fugax and stroke
2013, Clinical Neurology and Neurosurgery
SIR 2003 film panel case 7: Arterial thoracic outlet syndrome presenting with upper extremity emboli and posterior circulation stroke
2003, Journal of Vascular and Interventional Radiology
Bilateral carotid artery thrombosis in a young man
1993, Journal of Vascular Surgery
Carotid artery thrombosis in young patients without evidence of premature atherosclerosis prompts investigation of unusual forms of carotid disease in addition to a workup for cardiac and arch vessel sources for emboli. Noninvasive imaging and conventional angiographic techniques play an important part in the diagnostic evaluation looking for potential vascular sources. Physicians should also be aware that, in addition, hypercoagulable conditions may predispose to carotid thrombosis. One such patient is presented with bilateral carotid thrombosis and stroke. The management of the problem is reviewed, as well as the investigation of potential hypercoagulable conditions, with a primary focus on qualitative and quantitative platelet abnormalities. (J VASC SURG 1993;17:790-3.)

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RETROGRADE CEREBRAL EMBOLISM

Abstract

Lancet

A case of spreading obliterative arteritis

Trans Clin Soc Lond

Further notes of a case of obliterative arteritis

Trans Clin Soc Lond

A brachiocephalic vascular syndrome associated with cervical rib

Br Med J

Pathology

Two cases of thrombosis of subclavian artery, with contralateral hemiplegia of sudden onset, probably embolic

Brain

Aneurysm of axillary artery with cerebral embolus

U.S. Navy Med Bull