TY - JOUR
T1 - Vertebral artery compression resulting from head movement
T2 - A possible cause of the sudden infant death syndrome
AU - Pamphlett, Roger
AU - Raisanen, Jack
AU - Kum-Jew, Stephen
PY - 1999/2
Y1 - 1999/2
N2 - Objective. Vertebral artery compression causing brainstem ischemia has been suggested to underlie the sudden infant death syndrome. Vertebral artery distortion from neck movements has been demonstrated by angiography in infants, but direct evidence for arterial compression is lacking. In an attempt to demonstrate vertebral artery compression from head movement, we examined at postmortem the vertebral arteries of infants after neck extension or rotation. Methods. The C1-C7 spinal column, together with a 2-cm rim of skull base, was removed from 20 infants dying from sudden infant death syndrome or other causes. In 5 cases the neck was extended, in 9 cases it was rotated 90°to the right, and in 6 cases the neck was held in the neutral position. The neck was maintained in these positions during formalin fixation, and serial sections of selected blocks were examined microscopically. Results. In 3 of 5 extended cases, bilateral vertebral artery compression was seen between the occipital bone and C1. In 3 of 9 rotated cases, the left vertebral artery was compressed adjacent to C1 before the artery entered the transverse foramen. No vertebral artery compression was seen in the necks held in the neutral position. Conclusions. The vertebral arteries of some infants can be compressed by neck movement. This could induce lethal brainstem ischemia in infants with inadequate collateral blood flow or with poor compensatory arterial dilatation, and may underlie some cases of sudden infant death syndrome.
AB - Objective. Vertebral artery compression causing brainstem ischemia has been suggested to underlie the sudden infant death syndrome. Vertebral artery distortion from neck movements has been demonstrated by angiography in infants, but direct evidence for arterial compression is lacking. In an attempt to demonstrate vertebral artery compression from head movement, we examined at postmortem the vertebral arteries of infants after neck extension or rotation. Methods. The C1-C7 spinal column, together with a 2-cm rim of skull base, was removed from 20 infants dying from sudden infant death syndrome or other causes. In 5 cases the neck was extended, in 9 cases it was rotated 90°to the right, and in 6 cases the neck was held in the neutral position. The neck was maintained in these positions during formalin fixation, and serial sections of selected blocks were examined microscopically. Results. In 3 of 5 extended cases, bilateral vertebral artery compression was seen between the occipital bone and C1. In 3 of 9 rotated cases, the left vertebral artery was compressed adjacent to C1 before the artery entered the transverse foramen. No vertebral artery compression was seen in the necks held in the neutral position. Conclusions. The vertebral arteries of some infants can be compressed by neck movement. This could induce lethal brainstem ischemia in infants with inadequate collateral blood flow or with poor compensatory arterial dilatation, and may underlie some cases of sudden infant death syndrome.
KW - Brainstem
KW - Ischemia
KW - Prone sleeping
KW - SIDS
KW - Vertebral artery
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U2 - 10.1542/peds.103.2.460
DO - 10.1542/peds.103.2.460
M3 - Article
C2 - 9925842
AN - SCOPUS:0032990573
SN - 0031-4005
VL - 103
SP - 460
EP - 468
JO - Pediatrics
JF - Pediatrics
IS - 2
ER -