Carotid Compression and Rotation of the Head in Occlusive Vertebral Artery Disease

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Abstract
Eighteen patients with symptoms due to vertebral-basilar artery insufficiency as shown by arteriography were studied by combined digital compression of one carotid artery and rotation or extension of the head (which tends to compress or kink the vertebral artery) while changes in the eeg, ecg and pressure were continuously recorded. No eeg changes appeared with rotation of the head, hyperextension of the neck, or with both of these maneuvers combined. Seven patients (41%) with vertebral-basilar artery disease developed eeg changes on head-turning with carotid compression. Four of these 7 patients developed slow activity on digital carotid compression with the head in the neutral position, but on carotid compression with the head turned they developed a marked increase in slow activity or spike and slow-wave activity. Three patients developed slow activty and/or spikes and slow-wave activity on digital carotid compression solely with head-turning, but no eeg changes were produced by carotid compression with the head in tne neutral position alone. Possible mechanisms responsible for the eeg changes observed are discussed, and evidence is presented to show that head-turning may produce a reduction of cerebral blood flow by compression of the vertebral arteries. Eeg recording with carotid compression before and after head- turning is a useful diagnostic test in cases of suspected vertebral-basilar arterial insufficiency due to atherosclerosis or cervial spon-dylosis.

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