Early detection of vertebral artery dissection

2018 ◽  
Vol 11 (1) ◽  
pp. e226902
Author(s):  
Alice Morag MacArthur ◽  
Syed Mehdi
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Artery Aneurysm ◽  
Sudden Onset ◽  
Artery Dissection ◽  
Left Middle Cerebral Artery ◽  
Ct Angiogram ◽  
Neurology Clinic ◽  
History Of ◽  
Cerebral Artery Aneurysm

A 36-year-old female patient presented to hospital with a 1-week history of occipital headache. It was sudden onset following a fall into a swimming pool. Examination was unremarkable. CT angiogram brain scan showed right vertebral artery dissection with a 1 cm dissection flap and a 3 mm left middle cerebral artery aneurysm. She was discharged on aspirin, with outpatient neurology clinic follow-up.

Mild trauma causing cervical fracture through transverse foramen leading to a vertebral arteriovenous fistula

2021 ◽  
Vol 14 (6) ◽  
pp. e241735
Author(s):  
Mikkel Schou Andersen ◽  
Willy Krone ◽  
Sune Munthe
Keyword(s):  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Digital Subtraction ◽  
Trauma Mechanism ◽  
Transverse Foramen ◽  
Cervical Fractures ◽  
Vertebral Arteriovenous Fistula ◽  
Ct Angiogram

Vertebral arteriovenous fistula (vAVF) is an uncommon vascular disease defined as abnormal connections between the vertebral artery or its branches extracranially with nearby venous structures. This case report outlines the case of a man in his late 70s presenting with C1–C3 fractures after a mild trauma falling down a small staircase. CT angiogram (CTA) gave suspicion of vertebral artery dissection and pseudoaneurysm; however, digital subtraction angiography revealed a fracture-induced vAVF successfully treated endovascularly with coils. In conclusion, cervical fractures involving the transverse foramen regardless of trauma mechanism should result in a CTA. Endovascular treatment with ipsilateral vertebral artery closure is preferred due to its feasibility and safety.

Conus Perimedullary Arteriovenous Fistula with Intracranial Drainage: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 457-462 ◽  
Author(s):  
G. Edward Vates ◽  
Alfredo Quiñones-Hinojosa ◽  
Van V. Halbach ◽  
Michael T. Lawton
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Venous Drainage ◽  
Sudden Onset ◽  
Clinical Findings ◽  
Left Middle Cerebral Artery ◽  
Lower Extremity Weakness ◽  
Posterior Laminectomy ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

Abstract OBJECTIVE AND IMPORTANCE Perimedullary arteriovenous fistulae (AVFs) do not commonly present with subarachnoid hemorrhage or intracranial venous drainage causing neurological symptoms. We present a case with both of these features. The patient was inadvertently treated for an unruptured intracranial aneurysm before his true problem was recognized. CLINICAL PRESENTATION A 65-year-old man presented with sudden-onset lower-extremity weakness, diplopia, nausea, and dysarthria on the day of admission. A lumbar puncture documented subarachnoid hemorrhage, and imaging studies revealed a left middle cerebral artery aneurysm. It was noted during surgery that this aneurysm was unruptured, and the patient did not exhibit improvement after surgery. INTERVENTION Spinal angiography demonstrated a spinal perimedullary AVF feeding from the left T12 radicular artery; venous drainage extended rostrally into the posterior fossa venous system. The AVF was surgically occluded via a posterior laminectomy at the level of the AVF. After surgery, the patient's symptoms began to abate. CONCLUSION Conus perimedullary AVFs can have venous drainage that extends as far as intracranial veins, which can lead to confusing clinical findings because the symptoms may suggest an intracranial process, although the lesion is in the spine. Surgeons must be aware of this confusing presentation.

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

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.

scholarly journals Minor Trauma Causing Stroke in a Young Athlete

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.

scholarly journals Postpartum vertebral artery dissection: case report and review of the literature

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Nicholas T. Manasewitsch ◽  
Ahmed A. Hanfy ◽  
Bryce D. Beutler ◽  
Daniel Antwi-Amoabeng ◽  
Moutaz Taha ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Iron Deficiency ◽  
Vertebral Artery ◽  
Iron Deficiency Anemia ◽  
Vertebral Artery Dissection ◽  
Deficiency Anemia ◽  
Artery Dissection ◽  
Hypertensive Disorder ◽  
Acute Hemorrhage ◽  
History Of

Abstract Background Hypertensive disorders of pregnancy are associated with vascular complications, including ischemic stroke and cervical artery dissection. Vertebral artery dissection (VAD), however, is rare. We describe a 31-year-old female who presented with vertigo, nausea, and vomiting and was found to have a VAD. In addition, we discuss the presentation, differential diagnosis, and pathogenesis of this uncommon but clinically significant vascular event and summarize other cases of vertebral artery dissection described in the medical literature. Case presentation A 31-year-old Hispanic woman presented 10 days postpartum with a one-day history of vertigo, nausea, vomiting, and frontal headache. The patient’s pregnancy course had been complicated by preeclampsia, chorioamnionitis, and iron-deficiency anemia, and her delivery was complicated by acute hemorrhage. Physical examination was significant for left leg ataxia. Laboratory studies showed marked thrombocytosis. Emergent computed tomography (CT) scan of the head was obtained and revealed a left cerebellar ischemic large vessel stroke. Subsequent CT angiography of the head and neck showed a left VAD. Based on correlation of the clinical history and laboratory and imaging findings, a diagnosis of vertebral artery dissection secondary to reactive (secondary) thrombocytosis from overlapping iron-deficiency anemia and acute hemorrhage was established. The patient was started on a heparin infusion and experienced significant improvement after a four-day hospitalization. Conclusion VAD is a rare but important cause of neurologic symptoms in the postpartum period and should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women aged 30 years or older and those with a history of a hypertensive disorder of pregnancy are at particularly high risk. Prompt diagnosis and management of VAD is essential to ensure favorable outcomes.

scholarly journals Atraumatic Vertebral Artery Dissection in a Patient With a Migraine Headache

2021 ◽  
Author(s):  
Michael L Lloyd ◽  
Samuel Billingslea ◽  
Richard Slama
Keyword(s):  
Emergency Department ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Intravenous Contrast ◽  
Lingual Gyrus ◽  
History Of ◽  
High Index Of Suspicion ◽  
Persistent Headache

ABSTRACT This case discusses a 34-year-old active duty male who presented to the emergency department with a 2-week persistent headache. His initial review of symptoms was reassuring until a detailed neurologic examination on his second visit revealed a visual deficit in the left upper quadrant. Additionally, he complained of intermittent tension headaches for the last several years but had no history of diagnosed migraines until he was seen 4 days prior for empiric migraine therapy in the same emergency department and left without improvement in symptoms. On his return visit, computerized tomography scan with intravenous contrast revealed a left vertebral artery dissection and hematoma. The patient was admitted for medical management and subsequently found to have suffered a small infarction of right lingual gyrus cortex on magnetic resonance imaging. This case illustrates the importance of maintaining a broad differential diagnosis and high index of suspicion in the patient with new focal neurologic findings in order to diagnose a potentially fatal disease.

scholarly journals Early reappearance of disappeared ruptured small aneurysm with concomitant vertebral artery dissection

2018 ◽  
Vol 24 (6) ◽  
pp. 639-642 ◽  
Author(s):  
Eugen Enesi ◽  
Arben Rroji ◽  
Fatmir Bilaj ◽  
Eni Reka ◽  
Adrian Ndroqi ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Aneurysm ◽  
Artery Dissection ◽  
Vitro Fertilization ◽  
Ruptured Intracranial Aneurysm ◽  
Frequent Event

Thrombosis of a previously ruptured intracranial aneurysm is a frequent event and it most commonly occurs in large or giant aneurysms. We present a dynamic short-term follow-up and management of thrombosis in a ruptured small posterior inferior cerebellar artery aneurysm with concomitant vertebral artery dissection (VAD). Clinical and radiological follow-up findings and reviewed literature on thrombosis of small ruptured aneurysms are the focus of this presentation. Early reappearance of a disappeared ruptured small cerebral aneurysm with a concomitant VAD may be attributed to the controlled ovarian hyperstimulation phase of in vitro fertilization and prolonged use of oral contraceptive pills.

scholarly journals Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Francesca Monari ◽  
Stefano Busani ◽  
Maria Giovanna Imbrogno ◽  
Isabella Neri ◽  
Massimo Girardis ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cervical Spine ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Caucasian Woman ◽  
Ischemic Lesion ◽  
History Of ◽  
Cervical Spine Manipulation ◽  
In Pregnancy

Abstract Background Vertebral artery dissection is an uncommon, but potentially fatal, vascular event. This case aimed to describe the pathogenesis and clinical presentation of vertebral artery dissection in a term pregnant patient. Moreover, we focused on the differential diagnosis, reviewing the available evidence. Case presentation A 39-year-old Caucasian woman presented at 38 + 4 weeks of gestation with a short-term history of vertigo, nausea, and vomiting. Symptoms appeared a few days after cervical spine manipulation by an osteopathic specialist. Urgent magnetic resonance imaging of the head was obtained and revealed an ischemic lesion of the right posterolateral portion of the brain bulb. A subsequent computed tomography angiographic scan of the head and neck showed a right vertebral artery dissection. Based on the correlation of the neurological manifestations and imaging findings, a diagnosis of vertebral artery dissection was established. The patient started low-dose acetylsalicylic acid and prophylactic enoxaparin following an urgent cesarean section. Conclusion Vertebral artery dissection is a rare but potential cause of neurologic impairments in pregnancy and during the postpartum period. It should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women with a history of migraines, hypertension, or autoimmune disorders in pregnancy are at higher risk, as well as following cervical spine manipulations. Prompt diagnosis and management of vertebral artery dissection are essential to ensure favorable outcomes.

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