Diagnosis of vertebral artery dissection in childhood posterior circulation arterial ischaemic stroke

Background: Vertebral artery dissection (VAD) is well recognized cause of stroke in young and middle aged individuals. But, prognostic factor of posterior circulation ischemic stroke or transient ischemic attack (TIA) caused by intracranial VAD has been rarely discussed. Our aim was to evaluate the predictors of poor outcomes in posterior circulation ischemic stroke caused by intracranial VAD. Methods: We retrospectively reviewed patients with posterior circulation ischemic stroke or TIA caused by intracranial VAD using high-resolution vessel wall MRI who were recruited from Samsung Medical Center Stroke Registry (between January 1, 2011 and April 30, 2019). Poor outcomes were defined as a 3-months modified Rankin scale (mRS) score ≥ 2. Results: We registered 96 patients (74 males; mean age, 58.9±14.2 years) with acute posterior circulation ischemic stroke or TIA caused by intracranial VAD. Trauma history associated with VAD was presented in 23 (24%) of patients. Headache and neck pain around neurological symptom onset were presented in 41 (42.7%) and 19 (19.8%) of patients, respectively. Dissecting aneurysm, bilateral vertebral artery involvement, basilar artery involvement and wall hematoma with dissection were presented in 26 (27.1%), 26 (27.1%), 12 (12.5%) and 66 (68.8%) of patients, respectively. Of the 96 VADs, 26 (27.1%) presented with focal stenosis, 21 (21.9%) with multifocal stenosis, and 57 (59.4%) with occlusion. Lateral medulla involvement and multiple territory involvement were presented in 35 (36.5%) and 31 (32.3%) of patients. Recurrence rate of ischemic stroke or TIA within 90 days of symptom onset was 6.25%. Twenty-nine patients (30.2%) had poor outcomes at 3 months. Lateral medulla involvement was an independent predictor for poor outcome (odds ratio=3.293, 95% confidence interval=1.301-8.333, p=0.012). Conclusion: Posterior circulation ischemic stroke or TIA caused by intracranial VAD is associated with relatively benign clinical course. But the presence of lateral medulla involvement is independent predictor for poor outcome. Patients presenting lateral medullary infarction caused by intracranial VAD should be monitored closely.

Download Full-text

Combined thrombolysis in posterior circulation stroke caused by bilateral vertebral artery dissection in squash player

Neurologia i Neurochirurgia Polska ◽

10.1016/j.pjnns.2014.07.010 ◽

2014 ◽

Vol 48 (4) ◽

pp. 299-304 ◽

Cited By ~ 3

Author(s):

Emilia Frankowska ◽

Krzysztof Brzozowski ◽

Jacek Staszewski ◽

Norbert Kolmaga ◽

Adam Stępień ◽

...

Keyword(s):

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Posterior Circulation ◽

Artery Dissection ◽

Posterior Circulation Stroke

Download Full-text

Medical and Interventional Therapy for Spontaneous Vertebral Artery Dissection in the Craniocervical Segment

BioMed Research International ◽

10.1155/2017/7859719 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Guiyun Zhang ◽

Zuoquan Chen

Keyword(s):

Ischemic Stroke ◽

Vertebral Artery ◽

Conservative Therapy ◽

Vertebral Artery Dissection ◽

Clinical Manifestations ◽

Interventional Therapy ◽

Posterior Circulation ◽

Artery Dissection ◽

Stroke In The Young ◽

Ischemic Attack

Background and Purpose. Spontaneous vertebral artery dissection (SVAD) is an important reason for posterior-circulation-ischemic stroke in the young and middle-aged population. Although some previous reports reveal a favorable outcome with conservative therapy, it is still controversial in the treatment of SVAD in some specific patients. Herein, we present our 10 years of clinical experience for SVAD at this location. Material and Methods. 20 patients with 20 SVADs in V2 and V3 segments were retrospectively studied. Clinical manifestations and imageology materials were collected and analyzed. All the patients underwent anticoagulation except for one patient because of contraindication. 14 patients underwent Wingspan stents implantation with general anesthesia. Results. In our sample, ischemia (infarction or transient ischemic attack, TIA) was found in all the patients. Angiographic stenosis and dissection aneurysm were the most common findings in the segments mentioned above. 19 of the patients (95%) got the excellent imageological and clinical outcomes. Conclusions. According to our experience in this group, although anticoagulation is effective in vertebral artery dissection, interventional therapy for SVADs in V2 and/or V3 segments is preferred in some specific patients. Stent with higher radial supporting and flexibility, such as Wingspan stent, is suggested.

Download Full-text

Bilateral vertebral artery dissection complicated by posterior circulation stroke in a young man

Medicine ◽

10.1097/md.0000000000022822 ◽

2020 ◽

Vol 99 (44) ◽

pp. e22822

Author(s):

Zhichao Li ◽

Junni Liu ◽

Xiang Wang ◽

Xiaohui Liu ◽

Qinjian Sun ◽

...

Keyword(s):

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Posterior Circulation ◽

Artery Dissection ◽

Posterior Circulation Stroke

Download Full-text

Posterior Circulation Hyperperfusion Syndrome after Superficial Temporal Artery–Superior Cerebellar Artery Bypass for Vertebral Artery Dissection

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2013.04.037 ◽

2014 ◽

Vol 23 (3) ◽

pp. 583-586 ◽

Cited By ~ 5

Author(s):

Kenji Fukuda ◽

Hiroshi Abe ◽

Tetsuya Ueba ◽

Masakazu Okawa ◽

Toshio Higashi ◽

...

Keyword(s):

Vertebral Artery ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Vertebral Artery Dissection ◽

Temporal Artery ◽

Posterior Circulation ◽

Superior Cerebellar Artery ◽

Artery Dissection ◽

Hyperperfusion Syndrome ◽

Cerebellar Artery

Download Full-text

P.105 Missed vertebral artery dissection: a case series

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.207 ◽

2018 ◽

Vol 45 (s2) ◽

pp. S44-S44

Author(s):

A Persad ◽

B Stewart

Keyword(s):

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Case Series ◽

Posterior Circulation ◽

Artery Dissection ◽

Minor Trauma ◽

Posterior Circulation Stroke ◽

Acute Infarction ◽

History Of ◽

Neck Manipulation

Background: Vertebral artery dissections are the second most common cause of posterior circulation stroke. Particularly in young people, they must be considered as causes of acute infarction, especially with a history of cervical trauma. Here, we present three cases of vertebral artery dissection that were initially not diagnosed as such. All were caused by uncommon mechanisms; one by self-inflicted neck manipulation, and one as a sequela of falling from a trampoline, and one from minor trauma to the head while standing. Methods: This is a series of three cases seen by the authors of posterior circulation stroke secondary to vertebral artery dissection caused by uncommon mechanisms. Results: N/A Conclusions: Vertebral artery dissection should be considered as a differential diagnosis in patients presenting with acute head and/or neck pain and any neurological findings in relation to acute neck trauma.

Download Full-text