Posterior Communicating Artery Hypoplasia: A Risk Factor for Vertebral Artery Dissection Causing Subarachnoid Hemorrhage

Abstract Subarachnoid hemorrhage represents a rare event in pregnancy with a high mortality rate. We present the case of a 39-year-old pregnant woman who developed right vertebral artery dissection with subsequent massive subarachnoid hemorrhage with fatal outcome. The macroscopic and microscopic autopsy findings are described. A review of the literature with a discussion of the varied predisposing factors for vertebral artery dissection and subarachnoid hemorrhage and the rarity of these events in pregnancy is provided.

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Sumo-Associated Traumatic Vertebral Artery Dissection Precipitating Subarachnoid Hemorrhage in Association with Bifid Origins of the Posterior Inferior Cerebellar Artery

World Neurosurgery ◽

10.1016/j.wneu.2019.09.164 ◽

2020 ◽

Vol 134 ◽

pp. 641-646.e4

Author(s):

Hidenori Hoda ◽

Hirokazu Takami ◽

Christopher S. Graffeo ◽

Kazuo Hanakawa ◽

Masaki Komiyama ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Cerebellar Artery

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Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage: clinical and histopathological investigations from a medicolegal perspective

Journal of Neurosurgery ◽

10.3171/2008.11.jns08951 ◽

2009 ◽

Vol 110 (5) ◽

pp. 948-954 ◽

Cited By ~ 49

Author(s):

Ayako Ro ◽

Norimasa Kageyama ◽

Nobuyuki Abe ◽

Akihiro Takatsu ◽

Tatsushige Fukunaga

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Clinical Features ◽

Cross Sections ◽

Fatal Outcome ◽

Vertebral Artery Dissection ◽

Clinical History ◽

Clinical Diagnostics ◽

Artery Dissection ◽

Prodromal Symptoms

Object Subarachnoid hemorrhage (SAH) due to a ruptured intracranial vertebral artery (VA) dissection sometimes results in a sudden fatal outcome. The authors analyzed the relationship between clinical features and histopathological characteristics among fatal cases to establish valuable information for clinical diagnostics and prophylaxis. Methods This study included 58 medicolegal autopsy cases of ruptured intracranial VA dissection among 553 fatal nontraumatic cases of SAH that occurred between January 2000 and December 2007. Their clinical features were obtained from autopsy records. Histopathological investigations were performed on cross-sections obtained from all 4-mm segments of whole bilateral intracranial VAs and prepared with H & E and elastica van Gieson staining. Results The autopsy cases included 47 males and 11 females, showing a marked predilection for males. The mean age was 46.8 ± 7.7 years, with 78% of the patients in their 40s or 50s. Hypertension was the most frequently encountered history; it was found in 36% of cases from clinical history and in 55% of cases based on autopsy findings. Prodromal symptoms related to intracranial VA dissections were detected in 43% of patients. Headache or neck pain lasting hours to weeks was a frequent complaint. Of patients with prodromal symptoms, 44% had consulted doctors; however, in none of these was SAH or intracranial VA dissection diagnosed at a preventable stage. Autopsy revealed fusiform aneurysms with medial dissecting hematomas. Apart from ruptured intracranial VA dissection, previous intracranial VA dissection was detected in 25 cases (43%); among them, 10 showed previous dissection of the bilateral intracranial VAs. The incidence of prodromal symptoms (60%) among the patients with previous intracranial VA dissection was significantly higher than that (30%) among cases without previous dissection (chi-square test; p = 0.023). Most previous intracranial VA dissections formed a single lumen resembling nonspecific atherosclerotic lesions, with the exception of 3 cases (12%) with a double lumen. Conclusions Intracranial VA dissection resulting in fatal SAH frequently affects middle-aged men with untreated hypertension. Related to the high frequency of prodromal symptoms, latent previous intracranial VA dissection was histopathologically detected. Furthermore, intracranial VA dissection tends to induce multiple lesions affecting both intracranial VAs recurrently. This suggests the importance of an awareness of sustained whole intracranial VA vulnerability for the prevention of recurrence. The incidence of prodromal symptoms was significantly higher among patients with previous intracranial VA dissections. Thus, earlier diagnosis of intracranial VA dissections at the unruptured stage is desirable for prophylaxis against fatal SAH.

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A case of unilateral vertebral artery dissection progressing in a short time period to bilateral vertebral artery dissection

Surgical Neurology International ◽

10.25259/sni-78-2019 ◽

2019 ◽

Vol 10 ◽

pp. 126

Author(s):

Kiyoshi Tsuji ◽

Akira Watanabe ◽

Nobuhiro Nakagawa ◽

Amami Kato

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

De Novo ◽

Vertebral Artery Dissection ◽

Contralateral Side ◽

Sudden Onset ◽

Acute Stage ◽

Artery Dissection ◽

Lateral Medullary Infarction ◽

The Right

Background: Vertebral artery dissection (VAD) is an important cause of stroke in young and middle- aged people. Bilateral occurrence of VAD is generally considered rare, but the number of reports of bilateral VAD has been increasing in recent years. In this paper, we report a case of de novo VAD on the contralateral side presenting with subarachnoid hemorrhage in the acute stage of cerebral infarction due to unilateral VAD. Case Description: A 52-year-old man developed sudden-onset left occipital headache, dizziness, dysphagia, and right-sided hemiparesthesia and was admitted to our hospital. Head magnetic resonance imaging on admission showed a left lateral medullary infarction due to the left VAD. At this point, the right vertebral artery was normal. However, on day 9 after onset, he suddenly presented with subarachnoid hemorrhage due to the right VAD. Emergency endovascular treatment was performed for the dissecting aneurysm of the right vertebral artery. The patient’s condition improved gradually after the procedure, and he was discharged with a modified Rankin Scale score of 1. Conclusion: Bilateral occurrence of VAD may be more common than previously believed. Even in cases of unilateral VAD, we need to pay attention to the occurrence of de novo VAD on the contralateral side.

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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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Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients

Journal of Neurosurgery ◽

10.3171/jns.2004.101.1.0025 ◽

2004 ◽

Vol 101 (1) ◽

pp. 25-30 ◽

Cited By ~ 86

Author(s):

Masaru Yamada ◽

Takao Kitahara ◽

Akira Kurata ◽

Kiyotaka Fujii ◽

Yoshio Miyasaka

Keyword(s):

Subarachnoid Hemorrhage ◽

Conservative Treatment ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Delayed Diagnosis ◽

Acute Stage ◽

Artery Dissection ◽

Content Type ◽

String Structure ◽

Fine Print

Object. Intracranial vertebral artery (VA) dissection with subarachnoid hemorrhage is notorious for frequent rebleeding and a poor prognosis. Nevertheless, some patients survive with a good final outcome. The factors associated with the prognosis of this disease are not fully understood and appropriate treatment strategies continue to be debated. The authors retrospectively evaluated the clinical features of conservatively treated patients to elucidate the relationship between the clinical and angiographic characteristics of the disease and final outcomes. Methods. This study includes 24 patients who were treated by conservative methods between 1990 and 2000. Conservative treatment was chosen because of delayed diagnosis, poor clinical condition, or anatomical features such as bilateral lesions and contralateral VA hypoplasia. Of nine patients with an admission Hunt and Kosnik Grade I or II, eight had good outcomes (mean follow-up period 8 years and 4 months). All 15 patients with Grade III, IV, or V died and in 10 of these the cause of death was rebleeding. Among the 24 patients, 14 suffered a total of 35 rebleeding episodes; in 10 (71.4%) of these 14 patients rebleeding occurred within 6 hours and in 13 (93%) within 24 hours. Compared with the survivors, there was a female preponderance (0.022) among patients who died. These patients also had significantly shorter intervals between onset and hospital admission (p = 0.0067), a higher admission Hunt and Kosnik grade (p = 0.0001), a higher incidence of prehospitalization (p = 0.0296) and postadmission (p = 0.0029) rebleeding episodes, and a higher incidence of angiographically confirmed pearl-and-string structure of the lesion (p = 0.0049). Conclusions. In our series of preselected patients, poor admission neurological grade, rebleeding episode(s), and lesions with a pearl-and-string structure were predictive of poor outcomes. Our findings indicate that patients with these characteristics may be candidates for aggressive attempts to prevent rebleeding during the acute stage. Patients without these characteristics may be good candidates for conservative treatment, especially those who survive the acute phase without rebleeding.

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Vertebral Artery Dissection: Risk Factor for Stroke in Young Populations

PsycEXTRA Dataset ◽

10.1037/e741342011-230 ◽

2009 ◽

Author(s):

Benjamin L. Gilbert ◽

Pennie S. Seibert ◽

Caitlin C. Otto ◽

Missy Coblentz ◽

Nichole Whitener ◽

...

Keyword(s):

Risk Factor ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Stroke In Young

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Treatment Strategies of Subarachnoid Hemorrhage from Bilateral Vertebral Artery Dissection: A Case Report and Literature Review Focusing on the Availability of Stent Placement

World Neurosurgery ◽

10.1016/j.wneu.2017.06.167 ◽

2017 ◽

Vol 106 ◽

pp. 1050.e11-1050.e20 ◽

Cited By ~ 2

Author(s):

Yasuo Murai ◽

Fumihiro Matano ◽

Shoji Yokobori ◽

Hidetaka Onda ◽

Hiroyuki Yokota ◽

...

Keyword(s):

Case Report ◽

Subarachnoid Hemorrhage ◽

Literature Review ◽

Vertebral Artery ◽

Stent Placement ◽

Vertebral Artery Dissection ◽

Treatment Strategies ◽

Artery Dissection

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Republished: Delayed subarachnoid hemorrhage 7 years after cerebellar infarction from traumatic vertebral artery dissection

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012507.rep ◽

2016 ◽

Vol 9 (4) ◽

pp. e9-e9

Author(s):

Michael A Silva ◽

Alfred P See ◽

Priyank Khandelwal ◽

Nirav J Patel ◽

Mohammad Ali Aziz-Sultan

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Cerebellar Infarction ◽

Radiographic Evidence ◽

Vessel Injury ◽

Cerebellar Artery ◽

The Right

Vertebral artery dissection (VAD) is an important cause of ischemic stroke and subarachnoid hemorrhage (SAH). Dissections presenting with ischemia rarely cause SAH after more than a few hours, especially without radiographic evidence of pseudoaneurysm. We successfully treated a patient for persistent vessel injury presenting with SAH 7 years after presenting with extracranial subocclusive dissection of the right vertebral artery and an associated right posterior inferior cerebellar artery stroke. This is one of only three reported cases of delayed SAH occurring more than 2 weeks after an initial ischemic presentation of a VAD, and the only one without radiographic evidence of pseudoaneurysm at standard follow-up duration.

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Dissecting aneurysm of the radiculomedullary artery originating from extracranial vertebral artery dissection in a patient with rheumatoid cervical spine disease: an unusual cause of subarachnoid hemorrhage

Journal of Neurosurgery Spine ◽

10.3171/spi-07/12/660 ◽

2007 ◽

Vol 7 (6) ◽

pp. 660-663 ◽

Cited By ~ 7

Author(s):

Shingo Toyota ◽

Akatsuki Wakayama ◽

Yasunori Fujimoto ◽

Shiro Sugiura ◽

Toshiki Yoshimine

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Dissecting Aneurysm ◽

Cranial Computed Tomography ◽

Artery Dissection ◽

Parent Artery ◽

Atlantoaxial Joint ◽

Computed Tomography Scanning ◽

Extracranial Vertebral Artery

✓The authors report the case of a 65-year-old woman with atlantoaxial subluxation caused by rheumatoid arthritis. The patient had been hospitalized because of an infection after a total-knee replacement, when she suddenly lost consciousness and became apneic after an episode of intractable neck pain. Cranial computed tomography scanning demonstrated subarachnoid hemorrhage (SAH), and angiography revealed a dissecting aneurysm of the radiculomedullary artery that had originated from an extracranial vertebral artery dissection at the level of the atlantoaxial joint. Although coil embolization for the parent artery, including the dissecting aneurysm, was performed successfully, the patient died of worsening infection. The authors believe that the SAH occurred because of a ruptured dissecting aneurysm in the intradural portion of the radiculomedullary artery.

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