Middle aged, overweight woman was admitted with critical ischemia
in the right upper limb. She was symptomatic for more than a month. In our
clinic (tertiary care hospital) it is uncommon to see patients with history
shorter than 1 week. She required trans brachial thrombectomy (in emergency)
and removal of the cervical rib (elective) and subclavian artery thrombectomy.
The vertebral artery was close to the scalenous anticus muscle. Yet the
thrombus in the subclavian artery rarely goes to the vertebral artery to cause
the thromboembolic stroke. But we never came across such a patient in the last 25 years in our practice. It is possible that the neurologist treating the stroke patient may miss cervical rib, if the patient has not been specifically examined and evaluated.
I came across a paper – where this information was
published, I thought it will be useful to you, if you are looking for this type
of information.
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 embolization 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.
J Clin Neurosci. 2013 Oct 4. pii:
S0967-5868(13)00514-6. doi: 10.1016/j.jocn.2013.07.030. [Epub ahead of print] Thromboembolic
stroke associated with thoracic outlet syndrome. Meumann EM, Chuen J, Fitt G, Perchyonok Y, Pond F, Dewey HM.
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