The vertebral arteries supply the posterior brain (brainstem, cerebellum, occipital lobes) via the basilar artery. PICA occlusion produces the lateral medullary syndrome (Wallenberg syndrome) — the most common brainstem stroke: ipsilateral facial numbness, contralateral body numbness, Horner syndrome, ataxia, hoarseness, and dysphagia. Vertebral artery dissection from chiropractic neck manipulation or spontaneous tearing produces Wallenberg syndrome in young adults.
| Origin | First part of the subclavian artery |
|---|
Vertebral artery injury in cervical spine surgery (lateral mass screw malposition or anterior approach dissection lateral to the uncovertebral joint) produces immediate massive haemorrhage. The vertebral artery is not in the transverse foramen at C7 in 5-7% of individuals. Vertebral artery angioplasty and stenting addresses symptomatic vertebrobasilar insufficiency from proximal vertebral stenosis.
Intimal tear from neck trauma or manipulation producing lateral medullary syndrome managed with anticoagulation to prevent thromboembolic stroke.
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