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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(11): 1182-1183
DOI: 10.1055/s-0042-1758395
Images in Neurology

The Sistine Chapel and clothesline signs: a tale of two arteries

O sinal da Capela Sistina e sinal do varal: um conto sobre duas artérias
Léo Coutinho 
1   Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Grupo de Doenças Neurológicas, Curitiba PR, Brazil.
,
João Matheus Tussolini Marcon 
2   Universidade Federal do Paraná, Curso de Medicina, Curitiba PR, Brazil.
,
Ellen Riedi Oliveira 
2   Universidade Federal do Paraná, Curso de Medicina, Curitiba PR, Brazil.
,
Camila Emi Fujiwara Murakami 
2   Universidade Federal do Paraná, Curso de Medicina, Curitiba PR, Brazil.
,
Jessica Castro Silva 
2   Universidade Federal do Paraná, Curso de Medicina, Curitiba PR, Brazil.
,
Juliano André Muzzio 
3   Universidade Federal do Paraná, Serviço de Neurologia, Unidade Cerebrovascular, Curitiba PR, Brazil.
,
Viviane Hiroki Flumignan Zetola 
3   Universidade Federal do Paraná, Serviço de Neurologia, Unidade Cerebrovascular, Curitiba PR, Brazil.
,
Marcos Christiano Lange 
3   Universidade Federal do Paraná, Serviço de Neurologia, Unidade Cerebrovascular, Curitiba PR, Brazil.
,
Carlos Alberto Engelhorn
4   Angiolab, Curitiba PR, Brazil.
,
Paulo Cesar Evaristo Souza 
5   Universidade Federal do Paraná, Serviço de Neurorradiologia, Curitiba PR, Brazil.
,
Hélio Afonso Ghizoni Teive 
1   Universidade Federal do Paraná, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Grupo de Doenças Neurológicas, Curitiba PR, Brazil.
6   Universidade Federal do Paraná, Serviço de Neurologia, Unidade de Distúrbios de Movimento, Curitiba PR, Brazil.
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An 83-year-old woman presented sudden vertigo, drop attack, and transient dysarthria after head hyperextension to see the Sistine Chapel ceiling, in the Vatican. Transcranial doppler ultrasound ([Figure 1]) suggested proximal basilar stenosis, confirmed by arteriography ([Figure 2]). Case 2: A 77-year-old woman presented a 1-year history of transient vertigo after hanging clothes on a clothesline. Transcranial doppler ultrasound ([Figure 3]) revealed left subclavian artery steal phenomenon secondary to proximal subclavian artery stenosis, confirmed by arteriography ([Figure 4]). They received stenting and dual antiplatelet therapy. Transient ischemic symptomatology triggered by head/neck and arm movements demands vertebrobasilar and subclavian evaluation.[1] [2] [3]

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Figure 1 Transcranial Doppler show signs of segmental increase in flow velocity in the proximal basilar artery, compatible with basilar artery stenosis.
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Figure 2 Brain arteriography showing severe stenosis in the proximal basilar artery (A). Postangioplasty control with stent in the proximal basilar artery (B).
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Figure 3 Systolic flow reversal in the left vertebral artery at transcranial doppler ultrasound (arrow), compatible with grade 2 subclavian steal syndrome (intermittent or partial).
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Figure 4 Cervical arteriography demonstrating a critical lesion in the origin of the left subclavian artery, promoting subclavian steal syndrome (A). Cervical arteriography after subclavian artery angioplasty with stent positioning (B) (C).

Authors' Contributions

LC: Organization and execution of the research project, writhing of the first draft and of the final manuscript; JMTM, ERO, CEFM, JCS, JAM, VHFZ, MCL, CAE, PCES: organization and execution of the research project, writing of the first draft of the manuscript; HAGT: conception of the research project, review and critique, writing of the final manuscript.




Publication History

Received: 08 May 2022

Accepted: 15 June 2022

Article published online:
28 December 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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