SIB #402- Rare Vertebrobasilar Artery Fenestration (NOT Vertebral Artery Dissection)
The Study: A case of multiple vertebrobasilar artery fenestration misdiagnosed as vertebral artery dissection
The Facts:
a. Fenestration of the vertebro-basilar artery is an uncommon congenital vascular anomaly, which is identified by incidental findings on imaging…”
b. This was a case report in which fenestration was mistaken for cerebral artery dissection following cervical manipulation.
c. The authors state this is the first case when a vertebra-basilar artery fenestration was mistaken for cerebral artery dissection.
d. A 66 year old patient experienced an acute onset of dizziness following chiropractic manipulation of the cervical spine.
e. Computed tomography angiography was used and the patient was initially diagnosed as having a vertebral artery dissection.
f. “However, vertebral artery fenestration at V1 segment was eventually identified by multi-directional digital subtraction angiography (DSA). Interestingly, concomitant vertebral fenestration at V3 segment, basilar fenestration and basilar artery tip aneurysm was also revealed by DSA.”
h. The authors stated, “In conclusion, we reported a patient with extremely rare abnormality of triple fenestration at vertebrobasilar artery with basilar tip artery aneurysm.”
i. They also note that this “was easily misdiagnosed as a VAD [vertebral artery dissection] due to the similar imaging morphology.”
j. The authors indicate that this gives doctors more information about a very rare condition so that they can more appropriately treat a case if it is encountered.
Take Home:
This is a rare condition that was misdiagnosed.
Reviewer's Comments:
So why did I do this Science in Brief on a very rare condition. Well, I want everyone to understand that during their careers they will encounter many different types of conditions. Most will be ones with which they are familiar but some will be uncommon. When I was a young practitioner, I read a little thing that was attributed to Mayo Clinic. It went something like this, “We’re Mayo Clinic. We’re the best diagnosticians in the world. We make lots of mistakes. How many do you make?” Did that really come from Mayo Clinic? Who knows? But if they didn’t say it they should have! Anyway, I still remember it and it has kept me scared for longer than many of you have been alive. A little fear is a good thing
Reviewer: Roger Coleman DC
Editor’s Comments:
For those of you not familiar with the term (I certainly wasn’t), Fenestration is defined as “the division of lumen of the vessel into two separate and parallel channels which rejoin distally. It usually does not have any clinical significance but an aneurysm may arise from the proximal part of fenestration.”
Editor: Mark R. Payne DC
Reference: Wang F, Wang X, Li X, Zheng H, Zhang Z. A case of multiple Vertebrobasilar artery fenestration misdiagnosed as vertebral artery dissection. BMC Neurol. 2020 Feb 20;20(1):63. doi: 10.1186/s12883-020-01642-2.
Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/32079531
Link to Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7033924/