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An unusual case of the syndrome of cervical rib with subclavian artery thrombosis and cerebellar and cerebral infarctions.

Jusufovic M, Sandset EC, Popperud TH, Solberg S, Ringstad G, Kerty E - BMC Neurol (2012)

Bottom Line: Cerebellar and cerebral infarctions caused by the syndrome of cervical rib with thrombosis of subclavian artery are very unusual.We report the case of a 49-year-old male patient with a right cervical rib compression leading to subclavian arterial thrombosis and both cerebellar and cerebral infarctions secondary to retrograde thromboembolisation.Follow-up imaging revealed partial resolution of the thrombosis after combined anti-coagulant and anti-platelet therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology, Oslo University Hospital, Oslo, Norway. mirzajus@hotmail.com

ABSTRACT

Background: Cerebellar and cerebral infarctions caused by the syndrome of cervical rib with thrombosis of subclavian artery are very unusual.

Case presentation: We report the case of a 49-year-old male patient with a right cervical rib compression leading to subclavian arterial thrombosis and both cerebellar and cerebral infarctions secondary to retrograde thromboembolisation. Follow-up imaging revealed partial resolution of the thrombosis after combined anti-coagulant and anti-platelet therapy. The cervical rib and first costa were surgically removed to prevent additional events.

Conclusion: Cervical rib vascular compression should be promptly diagnosed and treated in order to avoid further complications, including cerebrovascular ischemic events.

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Related in: MedlinePlus

Cervical rib (A) causing subclavian arterial thrombosis (A, B) and cerebellar (C) and cerebral infarctions (D). Computed tomography angiography with surface rendering demonstrates a cervical rib (A black arrow) causing subclavian arterial thrombosis on the right side. The right clavicle has been subtracted from the image. Reformation with maximum intensity projection of the same volume. The right subclavian artery (B asterisk) is occluded proximal to the thoracic outlet and refilled with contrast by collateral vessels before entering the axilla (white arrow). Diffusion imaging (B1000) reveals punctuate foci of acute infarctions in the right cerebellum in C and posterior right frontal lobe in D (white arrows).
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Figure 1: Cervical rib (A) causing subclavian arterial thrombosis (A, B) and cerebellar (C) and cerebral infarctions (D). Computed tomography angiography with surface rendering demonstrates a cervical rib (A black arrow) causing subclavian arterial thrombosis on the right side. The right clavicle has been subtracted from the image. Reformation with maximum intensity projection of the same volume. The right subclavian artery (B asterisk) is occluded proximal to the thoracic outlet and refilled with contrast by collateral vessels before entering the axilla (white arrow). Diffusion imaging (B1000) reveals punctuate foci of acute infarctions in the right cerebellum in C and posterior right frontal lobe in D (white arrows).

Mentions: CT angiography showed a right-sided subclavian thrombus extending retrograde into the right carotid artery bifurcation and into the proximal segment of the vertebral artery, consistent with artery thrombosis (Figure 1A, B). The aortic arch was without signs of dissection or atherosclerosis. Brain MRI showed acute/subacute infarctions within the right cerebellum and in the superior parietofrontal lobe (Figure 1C, D), suggestive of emboli originating from the occluded subclavian artery. Imaging also showed bilateral cervical ribs (Figure 1A) with the right longer than the left, leading to reduced space between the cervical rib and anterior scalene muscle and compression of the right subclavian artery. Other possible explanations for cerebral thromboembolism were excluded by normal thrombophilia screening and transoesophageal echocardiography. Carotid Doppler examination showed that clots in the carotid were from propagating subclavian thrombus and were not anchored by plaque. Vessel wall inflammation and malignancy-predisposing thrombosis were excluded by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT).


An unusual case of the syndrome of cervical rib with subclavian artery thrombosis and cerebellar and cerebral infarctions.

Jusufovic M, Sandset EC, Popperud TH, Solberg S, Ringstad G, Kerty E - BMC Neurol (2012)

Cervical rib (A) causing subclavian arterial thrombosis (A, B) and cerebellar (C) and cerebral infarctions (D). Computed tomography angiography with surface rendering demonstrates a cervical rib (A black arrow) causing subclavian arterial thrombosis on the right side. The right clavicle has been subtracted from the image. Reformation with maximum intensity projection of the same volume. The right subclavian artery (B asterisk) is occluded proximal to the thoracic outlet and refilled with contrast by collateral vessels before entering the axilla (white arrow). Diffusion imaging (B1000) reveals punctuate foci of acute infarctions in the right cerebellum in C and posterior right frontal lobe in D (white arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475120&req=5

Figure 1: Cervical rib (A) causing subclavian arterial thrombosis (A, B) and cerebellar (C) and cerebral infarctions (D). Computed tomography angiography with surface rendering demonstrates a cervical rib (A black arrow) causing subclavian arterial thrombosis on the right side. The right clavicle has been subtracted from the image. Reformation with maximum intensity projection of the same volume. The right subclavian artery (B asterisk) is occluded proximal to the thoracic outlet and refilled with contrast by collateral vessels before entering the axilla (white arrow). Diffusion imaging (B1000) reveals punctuate foci of acute infarctions in the right cerebellum in C and posterior right frontal lobe in D (white arrows).
Mentions: CT angiography showed a right-sided subclavian thrombus extending retrograde into the right carotid artery bifurcation and into the proximal segment of the vertebral artery, consistent with artery thrombosis (Figure 1A, B). The aortic arch was without signs of dissection or atherosclerosis. Brain MRI showed acute/subacute infarctions within the right cerebellum and in the superior parietofrontal lobe (Figure 1C, D), suggestive of emboli originating from the occluded subclavian artery. Imaging also showed bilateral cervical ribs (Figure 1A) with the right longer than the left, leading to reduced space between the cervical rib and anterior scalene muscle and compression of the right subclavian artery. Other possible explanations for cerebral thromboembolism were excluded by normal thrombophilia screening and transoesophageal echocardiography. Carotid Doppler examination showed that clots in the carotid were from propagating subclavian thrombus and were not anchored by plaque. Vessel wall inflammation and malignancy-predisposing thrombosis were excluded by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT).

Bottom Line: Cerebellar and cerebral infarctions caused by the syndrome of cervical rib with thrombosis of subclavian artery are very unusual.We report the case of a 49-year-old male patient with a right cervical rib compression leading to subclavian arterial thrombosis and both cerebellar and cerebral infarctions secondary to retrograde thromboembolisation.Follow-up imaging revealed partial resolution of the thrombosis after combined anti-coagulant and anti-platelet therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Neurology, Oslo University Hospital, Oslo, Norway. mirzajus@hotmail.com

ABSTRACT

Background: Cerebellar and cerebral infarctions caused by the syndrome of cervical rib with thrombosis of subclavian artery are very unusual.

Case presentation: We report the case of a 49-year-old male patient with a right cervical rib compression leading to subclavian arterial thrombosis and both cerebellar and cerebral infarctions secondary to retrograde thromboembolisation. Follow-up imaging revealed partial resolution of the thrombosis after combined anti-coagulant and anti-platelet therapy. The cervical rib and first costa were surgically removed to prevent additional events.

Conclusion: Cervical rib vascular compression should be promptly diagnosed and treated in order to avoid further complications, including cerebrovascular ischemic events.

Show MeSH
Related in: MedlinePlus