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Cervical facet joints injections and epidural injections are the two most common interventions in managing chronic cervical pain. The C2-C3 joint and the third occipital nerve are very dangerous targets to be injected due to the proximity of the vertebral artery in the last portion V3 from the transverse process of C2 to the foramen magno. This study demonstrates that the distance between the facet C2-C3 and vertebral artery increases of 90% by a 45 degrees head rotation. The position over mentioned seems to be more protective during the Third Occipital Nerve block and during the C2-C3 facet blockage because the vertebral and segmental arteries are shifted medially far and behind the articular pillar on coronal plane. The augmented distance is confirmed either by TC and ultrasound scan.

Atheromasic lesions and other pathologic conditions of the arterial vessels of the neck are the most frequent causes of cerebrovascular disease. Diagnostic imaging currently employs digital subtraction angiography (DSA), Doppler, and color-Doppler US to study these conditions. Digital subtraction intraarterial angiography (DSAA) can provide both an early diagnosis and an accurate preoperative depiction of neck vessels; however, in spite of its effective value, it still remains an invasive technique. Magnetic Resonance angiography (angio-MR) is the latest technique allowing the depiction of neck vessels morphology. It shares with digital angiography the capability of supplying spatial depiction of all the examined vascular structures, and with US its noninvasiveness. The authors investigated angio-MR capabilities in providing accurate and detailed images of neck arteries; the images were then compared with DSA ones. Thirty patients with cerebrovascular diseases were studied. MR imaging was performed with a 1.5 T unit with a dedicated coil, and gradient-echo sequences were employed. Refocused sequences for flow were acquired on both the coronal and the sagittal planes, with the following parameters: TR 40, TE 10, flip angle 25 degrees, acquisition volumes 80-35 mm, 64-15 frames. Digital angiography demonstrated 101 vascular lesions: 27 slight stenoses (less than 30%), 19 mild stenoses (31-70%), 12 severe stenoses (71-99%), 7 occlusions, 14 coilings, 7 kinkings, and 15 hypoplasias of vertebral artery. In slight stenoses, angio-MR underestimated the condition in 11/27 patients. In mild and severe stenoses, as well as in occlusive diseases, angio-MR tended to overestimate the condition. In coiling, kinking, and hypoplasia, angio-MR yielded the same results as DSA.

The Authors report the case of a 54 year old man who died suddenly for bulbar paralysis caused by a vertebrobasilar vascular system thrombosis due to compression by an aneurysmal cyst of the first two cervical vertebra. The diagnosis of bony tumour which they reached on the basis of angiography and t.c., has been confirmed and defined by the autopsy.

The arteriographic findings are described in a patient with classic migraine, who developed transitory neurologic complications, during vertebral arteriography by femoral cateterism. Serial films were taken during "comitata" migraine attack and show a progressive decrease in filling of the vertebral-basilar system and partial stenosis of vertebral artery.

The authors studies through the evoked potentials of the brain stem a group of patients affected from T.I.A. of the vertebro-basilar circulation. From the remarks of cases this examination results significant in 66%. The more characteristic remarks is the increase of absolute latency of V wave. It is also possible to follow contemporary the evolution of auditive brain pathways disease and clinical features in repeating the test.

BAEPs recordings and brain CT Scans have been conducted in 11 patients with RIAs of the vertebral-basilar system. Five patients presented recurrent transient ischemic attacks (TIAs) completely clearing in 24 h, while in the other patients a full recovery took place over a longer period, within 3 week (RINDs). Each patient underwent BAEPs recording, as well CT Scans, EEG and oto-neurological examination, 7-20 days after the last RIA, when all signs and symptoms had disappeared. Both ears were subsequently stimulated and bipolar EEG activity was recorded from Cz and the mastoid electrode ipsilateral to stimulation. At least two sets of 1500 averaged responses from each ear were added. The I-III, III-V, I-V interpeak latencies (IPLs) as well as the IV-V/I amplitude ratio were measured and compared with the values obtained in a control group. Increased IPLs were detected in 4 cases of the TIA group and in 2 of the RIND group. Amplitude ratio was always normal. Any positive information provided by CT Scan showed cerebral atrophy in 4 patients with TIAs and in 1 patient with RIND. BAEPs recording is a relatively simple, non-invasive neurophysiologic test, which can give objective evidence for brainstem dysfunction in vertebro-basilar RIAs.

The haemodynamic premises for extra-anatomical by-pass in the treatment of stenosis and obstructions of the subclavian and vertebral arteries are discussed with a report on a surgically treated series.