[Paroxysmal brain stem ischemia in a combination of thoracic outlet syndrome with contralateral subclavian steal syndrome].

Mechanical irritation of the right subclavian artery in the scalenus region and stenosis of the contralateral subclavian artery in combination with hypoplasia of the vertebral artery led to recurrent neurological symptoms in a 41 year-old female patient. Sudden loss of consciousness, episodes of dizziness, vomiting and paraesthesiae occurred as a result of manoeuvres involving turning the head and lifting the right arm. A significant blood pressure difference between both arms and a stenotic bruit were found. Angiography revealed the "subclavian steal syndrome" with stenosis of the left subclavian artery and hypoplasia of the left vertebral artery. On operation of the right scalenus region an atypically angled origin of the right vertebral artery was detected. After dissection of the scalenus anticus muscle and-in a second step-transaxillary resection of the first rib the patient has remained symptom-free for the past 24 months.