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For the first time in Armenia, in Erebouni MC. The patient ceased to stutter after surgery of compressed vertebral artery.

For the first time in Armenia, in Erebouni MC. The patient ceased to stutter after surgery of compressed vertebral artery.

For the first time in Armenia, in Erebouni MC. The patient ceased to stutter after surgery of compressed vertebral artery. At the beginning of September of 2016, the patient N.O., 34-year-old in the last week of pregnancy suffered from acute violation of cerebral circulation, which clinically manifested fainting, speech disorders, and further – stuttering, pronounced dizziness, discoordinated movement and severe headaches. With these complaints the patient consulted by a Head of neck and cardiac vessel surgery and stroke prevention unit of MC Erebouni M.P. Shatakhyan (MD,PhD) after which was convened a concilium, where together with obstetricians - gynecologists was decided to perform MRI of the neck vessels and brain. It was also decided to give birth by a Caesarean section under the general anesthesia.

 

Fig.1 Vertebra-carotid anastomosis.

 

The examination showed the presence of hypoplasia of the right vertebral artery as well as compression and deformation of the dominant left vertebral artery with expressed hemodynamic disorders of blood flow. The patient before surgery was under the direct supervision of Head of Department of High Risk Pregnancy of MC Erebouni E.E. Gharibyan MD. Delivery was managed by obstetrician-gynecologist T.A. Hovhannisyan and passed without any complications.

 

After discharge the patient was under medical supervision, receiving concomitant medication. Although neurologists prescribed medical therapy, improvement wasn`t observed, stuttering was intensified, which was the main cause of the patient`s suffering. After reaching a relatively quiet postpartum period the patient was scheduled for surgery by Doctor M. Shatakhyan, MD to impose left vertebral - carotid anastomosis to improve blood circulation in the corresponding areas of the brain. The left vertebral artery was compressed by branches of thoracic duct, which was the cause of its deformation.

 

In 28. 11.2016, by the surgical team (surgeons- M.P. Shatakhyan, S.I. Arzumanyan, the anesthesiologist - A. Muradyan, perioperative nurses - T.Sargsyan, N. Karapetyan) was carried out the surgery: the vertebral artery was cut off from the subclavian artery, freed from the branches of lymphatic duct, straightened, and then made its transposition into the carotid artery via imposition of anastomosis end-to-side (Fig.N1).

 

Immediately after waking up from general anesthesia the patient was able to speak clearly and distinctly, without stuttering. Also disappeared dizziness, uncoordinated movements. The patient was discharged on next day after surgery without any complications

 

 Violation of cerebral circulation due to pathology of the vertebral artery is a fairly common phenomenon. However, the stuttering among them is extremely rare. For this reason, is extremely valuable the experience of correction the stuttering by correction of vertebral artery pathology.

 

All of the above reaffirms how little is known about interrelation of the certain parts of the brain with pathological symptoms, manifested in violation of blood supply.

08.12.2016
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