Lateral Medullary Syndrome and Ipsilateral Hemiplegia (Opalski Syndrome) Due to Left Vertebral Artery Dissection

This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

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Left vertebral artery dissection causing bilateral internuclear ophthalmoplegia

CJEM ◽

10.1017/s1481803500010630 ◽

2008 ◽

Vol 10 (05) ◽

pp. 485-487

Author(s):

Glen Jickling ◽

Kelvin Leung ◽

Kenman Gan ◽

Ashfaq Shuaib ◽

James Lewis ◽

...

Keyword(s):

Emergency Department ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Clinical Findings ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Internuclear Ophthalmoplegia ◽

Gradual Improvement ◽

Brainstem Lesion ◽

Posterior Neck

ABSTRACT A 21-year-old woman presented to the emergency department 1 day after a fall. On the day of presentation, she awoke with horizontal diplopia and posterior neck pain. Based on clinical findings, she was diagnosed with bilateral internuclear ophthalmoplegia. A conventional angiogram identified a left vertebral artery dissection. She was started on anticoagulant therapy, with gradual improvement of her diplopia over several months. Diplopia is frequently seen in the emergency department. Internuclear ophthalmoplegia is a cause of binocular diplopia and is important to recognize because it indicates a brainstem lesion requiring neurologic evaluation.

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Combined reconstructive and deconstructive endovascular approach for bilateral vertebral artery dissection with subarachnoid hemorrhage

Neurosurgical FOCUS ◽

10.3171/2019.1.focusvid.18483 ◽

2019 ◽

Vol 46 (Suppl_1) ◽

pp. V13

Author(s):

Jacob Cherian ◽

Thomas P. Madaelil ◽

Frank Tong ◽

Brian M. Howard ◽

C. Michael Cawley ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Critical Flow ◽

Alternative Strategies ◽

Potential Alternative ◽

Endovascular Approach ◽

The Right

The video highlights a challenging case of bilateral vertebral artery dissection presenting with subarachnoid hemorrhage. The patient was found to have a critical flow-limiting stenosis in his dominant right vertebral artery and a ruptured pseudoaneurysm in his left vertebral artery. A single-stage endovascular treatment with stent reconstruction of the right vertebral artery and coil embolization sacrifice of the left side was performed. The case highlights the rationale for treatment and potential alternative strategies.The video can be found here: https://youtu.be/e0U_JE2jISw.

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Traumatic Vertebral Artery Dissection and Basilar Artery Occlusion/Stroke in a 7-Year-Old Child: A Case Report

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1692670 ◽

2019 ◽

Vol 08 (04) ◽

pp. 233-237

Author(s):

Binh Phung ◽

Trusha Shah

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Basilar Artery ◽

Vertebral Artery Dissection ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Life Threatening ◽

Computed Tomography Angiogram

AbstractVertebral artery dissection (VAD) followed by basilar artery occlusion/stroke (BAO/BAS) is a rare but potentially life-threatening complication. We present a case report of a 7-year-old boy with VAD complicated by BAO/BAS 4 days after falling off a scooter. Symptoms included left-sided weakness and facial droop preceded by a 20-minute episode of altered sensorium. Magnetic resonance imaging showed ischemic changes in the left posterior inferior cerebellum and right pons. Computed tomography angiogram confirmed dissection of the left vertebral artery with occlusion/thrombosis of the basilar artery. Heparinization for 96 hours, followed by 6 months of low-molecular weight heparin injection, resulted in improvement of his neurological symptoms.

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Right Vertebral Artery Transection With a Vertical Distraction of C5-6: Case Report of a Patient Survival

The American Surgeon ◽

10.1177/0003134820919725 ◽

2020 ◽

Vol 86 (5) ◽

pp. 531-533

Author(s):

Jared Griffard ◽

Reagan Bollig

Keyword(s):

Spinal Cord ◽

Case Report ◽

Vertebral Artery ◽

Spinal Cord Injuries ◽

Patient Survival ◽

Multidisciplinary Treatment ◽

Vertebral Artery Dissection ◽

Spinal Column ◽

Left Vertebral Artery ◽

Artery Dissection

Spinal column injuries are very commonly diagnosed in the multitrauma population, and extensive distraction injuries are often fatal due to cerebrovascular injuries or spinal cord injuries. We present a 62-year-old female who presented after an MVC with a 2-cm vertical distraction injury of C5-6 with a right vertebral artery transection and left vertebral artery dissection. She received multidisciplinary treatment which resulted in her survival, albeit with severe neurologic deficits. We challenge the current literature that suggests a blunt vertebral artery transection is 100% fatal.

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Bilateral Internal Carotid and Left Vertebral Artery Dissection after Blunt Trauma: A Case Report and Literature Review

Neurologia medico-chirurgica ◽

10.2176/nmc.cr.2018-0239 ◽

2019 ◽

Vol 59 (4) ◽

pp. 154-161 ◽

Cited By ~ 1

Author(s):

Kenichi ARIYADA ◽

Keita SHIBAHASHI ◽

Hidenori HODA ◽

Shinta WATANABE ◽

Masahiro NISHIDA ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Vertebral Artery ◽

Blunt Trauma ◽

Internal Carotid ◽

Vertebral Artery Dissection ◽

Left Vertebral Artery ◽

Artery Dissection

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Minor Trauma Causing Stroke in a Young Athlete

Case Reports in Neurological Medicine ◽

10.1155/2015/182875 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Vineet Gupta ◽

Naveen Dhawan ◽

Jaya Bahl

Keyword(s):

Differential Diagnosis ◽

Vertebral Artery ◽

Treatment Modality ◽

Vertebral Artery Dissection ◽

Young Athlete ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Minor Trauma ◽

The Third ◽

Ct Angiogram

A 17-year-old Caucasian male presented with sudden dizziness, ataxia, vertigo, and clumsiness lasting for a couple of hours. He had a subtle trauma during a wrestling match 2 days prior to the presentation. A CT Angiogram (CTA) and MRI showed left vertebral artery dissection (VAD). The patient was treated with anticoagulation with heparin drip in the ICU. The patient was discharged home on the third day on Lovenox-warfarin bridging. This case underscores the importance of considering VAD as a differential diagnosis in patients with sports-related symptoms especially in activities entailing hyperextension or hyperrotation of neck. Due to a varied latent period, often minor underlying trauma, and subtle presentation, a low index of suspicion is warranted in timely diagnosis and treatment of VAD. Considering recent evidence in treatment modality, either antiplatelet therapy or anticoagulation may be used for treatment of VAD.

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Lumbar Subdural Hematoma From Intracranial Subarachnoid Hemorrhage Presenting With Bilateral Foot Drop: Case Report

Neurosurgery ◽

10.1227/neu.0b013e3182078099 ◽

2011 ◽

Vol 68 (3) ◽

pp. E835-E839 ◽

Cited By ~ 5

Author(s):

James S Waldron ◽

Michael C Oh ◽

Dean Chou

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Subdural Hematoma ◽

Vertebral Artery Dissection ◽

Expectant Management ◽

External Ventricular Drainage ◽

Foot Drop ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Modest Improvement

Abstract BACKGROUND AND IMPORTANCE: We report a patient with lumbar subdural hematoma secondary to intracranial subarachnoid hemorrhage (SAH) presenting with bilateral foot drop and describe our management. CLINICAL PRESENTATION: A 37-year-old woman presented with grade 4 SAH and hydrocephalus requiring emergent external ventricular drainage. Angiography demonstrated a left vertebral artery dissection and pseudoaneurysm that was treated with embolization of the vertebral artery. Six days after admission, her neurologic examination significantly improved. She was awake, alert, following commands, and moving all her extremities normally except for bilateral foot drop. An MRI scan revealed a lumbar subdural hematoma with severe thecal sac compression at L4-S1. The patient was initially treated with expectant management followed by surgery after she demonstrated only modest improvement. Evacuation of the hematoma was undertaken by an L5-S1 laminectomy and drainage of the liquefied clot in the subdural, extra-arachnoid space. Postoperatively, the patient demonstrated improved strength in all muscle groups except for left lower extremity eversion. CONCLUSION: We present a case of subdural hematoma that caused bilateral foot drop. Neurologic improvement occured after evacuation of the hematoma.

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Simultaneous spontaneous arterial dissections in a 38-year-old woman presenting during the covid-19 pandemic: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab035 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Lynsey Hewitson ◽

Chih Wong ◽

Shahid Aziz ◽

Amardeep Dastidar

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Invasive Coronary Angiography ◽

Vertebral Artery Dissection ◽

High Sensitivity ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Minimal Risk ◽

Coronary Artery Dissection ◽

First Case

Abstract Background Spontaneous coronary artery dissection (SCAD) is an increasingly recognized and important cause of acute myocardial infarction, particularly in women under 50, often with minimal risk factors. Many patients have underlying arteriopathy, most commonly in the form of fibromuscular dysplasia. Case summary A 38-year-old woman presented to the hospital with chest pain and elevated high-sensitivity Troponin. Invasive coronary angiography demonstrated SCAD of the left anterior descending artery. The same day the patient developed a severe progressive headache and subsequent imaging revealed a left vertebral artery dissection. She was managed conservatively with optimal medical therapy and was successfully discharged from hospital on Day 7. Discussion To our knowledge, this is the first case report of simultaneous spontaneous coronary and vertebral artery dissections not related to pregnancy. It highlights not only the importance of recognizing and accurately diagnosing SCAD, but also of appreciating the possibility of underlying arteriopathy: this is paramount to ensuring appropriate investigations, follow-up and assessment of any unexplained symptoms in this patient group.

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