Synonym(s)
brachial-basilar insufficiency syndrome; subclavian steal effect; subclavian steal syndrome; Subclavian withdrawal syndrome; Tapping syndrome of the arteria vertebralis; Vertebralis tapping syndrome; withdrawal syndrome of the subclavian artery
DefinitionThis section has been translated automatically.
Cerebrovascular clinical picture, which leads to an obstruction of the proximal A. subclavia and thus to the tapping of the basilar tract, e.g. in subclavian steal syndrome.
EtiopathogenesisThis section has been translated automatically.
Mostly acquired disorder due to arteriosclerotic occlusion of the proximal part of the left subclavian artery, rarely of both subclavian arteries. Pathogenetically, the resulting drop in blood pressure distal to the vascular stenosis leads to a reversal of the flow direction in the closure-side vertebral artery and thus to the formation of a directed collateral circulation from the reciprocal subclavian artery via the two vertebral arteries to the poststenotic section of the subclavian artery. This current reversal in the vertebral artery, which is increased by increased blood demand after arm strain, leads to a "tapping" of the basilar current pathways in favour of the collateral circulation and to the disadvantage of the cerebral blood flow in the brainstem and cerebellum.
You might also be interested in
ManifestationThis section has been translated automatically.
Almost without exception older people with advanced arteriosclerosis.
Clinical featuresThis section has been translated automatically.
- In about 10% of patients image of calcinosis cutis or formation of atheroma, often months or years before the onset of acute symptoms.
- Frequently asymptomatic, if symptomatic: Signs of cerebrovascular insufficiency usually occurring in attacks (especially after arm work): dizziness, nausea, disturbances of consciousness, paresis and/or numbness of one half of the body, a limb or half of the face, transient speech and gait disturbances, appearance of double vision, hemianopsia, nystagmus, swallowing disorders, recurrent hemicrania.
- Signs of poor blood supply in one arm: differences in blood pressure between the two arms, differences in pulse, absence of a radial pulse, sensation of cold, par- or dysaesthesia, absence of a pulse in the supraclavicular pit, muscle weakness, pain on exertion in the sense of "intermittent limping". Symptoms may vary according to localisation and degree of stenosis, but also depending on the development of collateral circulation. If the collateral network is more extensive, sufficient blood supply to the brain can still be ensured despite the tapping and the brain symptoms may therefore be absent.
DiagnosisThis section has been translated automatically.
In the angiogram, stenosis or obliteration of the subclavian artery (or the brachiocephalic trunk) proximal to the vertebral junction and retrograde filling of the vertebral artery with contrast medium. Diagnosis also by Doppler sonography.
TherapyThis section has been translated automatically.
Surgical treatment by vascular surgeons. Skin changes serve as a diagnostic sign.
LiteratureThis section has been translated automatically.
- Contorni L (1960) Il circolo collaterale vertebro-vertebrale nella oblitrazione dell'arteria succlavia alla sua origine. Minerva about 15: 268-271
- Herring M (1977) The subclavian steal syndrome; a review. At the castle 43: 220-228
- Hull MC et al (2003) Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lymphoma treated with radiation therapy. JAMA 290: 2831-2837
- Kersten HG, Rau G, Höffken W, Heberer G (1964) The tapping syndrome of the vertebral artery in obliteration of the subclavian artery in section I (Subclavian steal syndrome). Med Clin: 1526-1530
- Reivich M, Holling HE, Roberts B, Toole JF (1961) Reversal of blood flow through the vertebral artery and its effect on cerebral circulation. N Engl J Med 265: 878-885
- Roldan-Valadez E et al (2003) Imaging diagnosis of subclavian steal syndrome secondary to Takayasu arteritis affecting a left-side subclavian artery. Arch Med Res 34: 433-438
Recommended articles
Incoming links (8)
Brachial-basilar insufficiency syndrome; Subclavian steal effect; Subclavian steal syndrome; Subclavian steal syndrome; Subclavian withdrawal syndrome; Tapping syndrome of the arteria vertebralis; Vertebralis tapping syndrome; Withdrawal syndrome of the subclavian artery;Disclaimer
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.
Prof. Dr. med. Peter Altmeyer