Rotational Stenosis of the First Segment of the Vertebral Artery through Compression by the Cervical Sympathetic Chain

Abstract

We report a patient who experienced episodes of vertigo, nausea, and vomiting caused by rotational vertebral artery stenosis at the first segment. At surgery it was found that the left vertebral artery was compressed by the cervical sympathetic chain 2 cm distal to its origin when the patient's head was turned to the right. The artery was also compressed by an osteophyte at the C6-7 level. The sympathetic chain was sectioned, the osteophyte was removed, and the transverse foramen of C6 was unroofed. Decompression of the vertebral artery conferred symptomatic relief. The literature concerning compression of the first segment of the vertebral artery is reviewed.