Vertebral Artery Halo Sign in Patients With Stroke

Abstract

The purpose of this study was to describe typical ultrasonographic findings of vertebral arteries in patients affected by giant cell arteritis. Color duplex sonography was used to asses the cervical arteries within 24 hours from stroke onset in 1237 patients. Vertebral arteritis was considered if concentric, homogeneous, and smooth hypoechogenic mural thickening (the so-called halo sign) was present in at least 1 cervical segment of the vertebral artery. If the patient showed such findings, an ultrasound examination of the temporal artery was also performed. Patients with probable giant cell arteritis were treated with high-dose intravenous methylprednisolone in association with antiplatelet therapy. Temporal artery biopsy was carried out by a vascular surgeon in the site targeted by the ultrasonographer. Five patients were diagnosed as having vertebral arteritis according to ultrasound criteria. All of them had initial neurological deficit due to infarctions affecting the vertebrobasilar territory. One patient died due to aspiration pneumonia, whereas the others were independent at discharge. All patients had a positive biopsy for giant cell arteritis. Vertebral artery involvement in giant cell arteritis may be suspected by color duplex sonography. This fact would allow a prompt diagnosis and treatment of this otherwise fatal disease. Because duplex ultrasonography is a usual test performed on patients with stroke, the recognition of the halo sign in vertebral arteries may be of crucial interest in selected cases.