Republished: Congenital anomaly of the posterior arch of the atlas: a rare risk factor for posterior circulation stroke

2017 ◽  
Vol 9 (7) ◽  
pp. e27-e27 ◽  
Author(s):  
Zhi-yuan Ouyang ◽  
Min-jian Qiu ◽  
Zhe Zhao ◽  
Xiao-bing Wu ◽  
Lu-sha Tong
Keyword(s):  
Vertebral Artery Dissection ◽  
Young Patients ◽  
Craniovertebral Junction ◽  
Posterior Circulation ◽  
Atlantoaxial Instability ◽  
Artery Dissection ◽  
Posterior Arch ◽  
Atlantoaxial Joint ◽  
Posterior Circulation Stroke ◽  
First Case

We report an extremely rare case involving a posterior arch anomaly of the atlas, causing a vertebral artery dissection (VAD) induced posterior circulation stroke. A 16-year-old girl was admitted to hospital because of new onset dizziness. VAD related multiple infarction in the posterior circulation was revealed. The congenital posterior arch anomaly of the atlas, along with instability of the atlantoaxial joint, were discovered accidentally during follow-up. This is the first case of ischemic stroke related to atlantal posterior arch aplasia and atlantoaxial instability. Although rare, it reminds us that investigation of the craniovertebral junction should be considered when stroke occurs in young patients.

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

2014 ◽  
Vol 48 (4) ◽  
pp. 299-304 ◽  
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

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

Medicine ◽  
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

Basilar invagination presenting as recurrent posterior circulation stroke with locked-in syndrome in a child: a case report

2017 ◽  
Vol 5 (1) ◽  
pp. 271
Author(s):  
Mukesh Kumar ◽  
Pooja Mehta ◽  
Pawan K. Garg
Keyword(s):  
Case Report ◽  
Cranial Nerves ◽  
Young Patients ◽  
Odontoid Process ◽  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Posterior Circulation ◽  
Cervical Cord ◽  
Stroke Treatment ◽  
Posterior Circulation Stroke

Basilar invagination is a type of craniovertebral junction anomaly which occurs when the tip of odontoid process migrates upward into the intracranial space through foramen magnum and most commonly present as progressive neurological deficit implicating the high cervical cord, lower brainstem and cranial nerves. It can rarely present as vertebro-basilar territory insufficiency and occlusion, leading to stroke. Treatment is typically surgical and continues to centre on varying combinations of anterior or posterior decompression with or without traction or fusion. We present a 13-year-old boy with basilar invagination diagnosed on MRI with angiogram, which was missed on initial presentation, leading to recurrent posterior circulation stroke progressed to Locked-in syndrome. This case report emphasis the need of screening for craniovertebral junction anomalies in young patients presenting with posterior circulation stroke.

scholarly journals P.105 Missed vertebral artery dissection: a case series

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.

Posterior Circulation Stroke due to Atlantoaxial Instability in CHST3-Related Skeletal Dysplasia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Arjun Dhawale ◽  
Shruti Bajaj ◽  
Kshitij Chaudhary ◽  
Tushar Agarwal ◽  
Sandeep Garg ◽  
...  
Keyword(s):  
Skeletal Dysplasia ◽  
Posterior Circulation ◽  
Atlantoaxial Instability ◽  
Posterior Circulation Stroke

D-Dimer As An Indicator of Vertebral Artery Dissection: A Case Control Study

2021 ◽  
Author(s):  
Atsuyuki Watanabe ◽  
Hiroshi Ito ◽  
Kazushi Maruo ◽  
Junzo Nakao ◽  
Takako Kaino ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Neck Pain ◽  
Vertebral Artery ◽  
Laboratory Data ◽  
Vertebral Artery Dissection ◽  
Young Patients ◽  
Artery Dissection ◽  
Diagnostic Model ◽  
Common Symptom ◽  
D Dimer

Abstract Background Vertebral artery dissection (VAD), which can possibly lead to stroke, presents various symptoms such as headache, neck pain, transient ischemic attacks, and vertigo. We evaluated the effect of D-dimer to distinguish VAD from benign diseases by retrospective single-center observational study. Methods All VAD cases received in the emergency department between January 2013 and June 2020 were reviewed. Comparing those cases to vertigo with benign etiologies, the correlation between VAD and D-dimer was analyzed. Using stepwise multivariate logistic regression, possible symptoms to suspect VAD were also determined from physical findings and some laboratory data, including D-dimer. Results Eleven patients were included in the VAD group, and 59 patients were enrolled in the control (benign vertigo [BV]) group. The most common symptom in VAD patients was hemiplegia (N = 7, 63.6%) and cranial neuropathy (N = 7, 63.6%), followed by classic occipital or posterior neck pain (N = 4, 36.4%), gait ataxia (N = 3, 27.3%), and confusion (N = 1, 9.1%). Two patients (18.2%) were free from any symptoms except vertigo. D-dimer was not significantly different between the two groups at the positive cutoff value of 500 ng/mL (p = 1). By stepwise selection, age (odds ratio (OR): 0.92, [0.87–0.98], p < 0.01) and systolic blood pressure (sBP; OR: 1.06 [1.02–1.10], p < 0.01) were selected in the diagnostic model. In combination, age under 60 and sBP over 160 mmHg yielded 63.6% sensitivity, 98.3% specificity, and 37.5 positive likelihood ratio. Conclusions In our study, D-dimer was not found to be an effective indicator of VAD. By contrast, disproportionate hypertension (high blood pressure in young patients) can be a key factor to suspect VAD. Future studies with larger sample sizes are warranted.

Anticoagulation vs Antiplatelet Treatment in Patients with Carotid and Vertebral Artery Dissection: A Study of 370 Patients and Literature Review

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 368-379 ◽  
Author(s):  
Badih Daou ◽  
Christine Hammer ◽  
Nikolaos Mouchtouris ◽  
Robert M. Starke ◽  
Sravanthi Koduri ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Vertebral Artery ◽  
Recurrent Events ◽  
Combined Treatment ◽  
Vertebral Artery Dissection ◽  
Young Patients ◽  
Artery Dissection ◽  
Antiplatelet Treatment ◽  
Hemorrhagic Events

Abstract BACKGROUND: Dissection of the carotid and vertebral arteries is an important cause of stroke in young patients. OBJECTIVE: The objective of this study is to compare antithrombotic treatments in patients with carotid and vertebral dissections. METHODS: Three hundred seventy patients with carotid and vertebral artery dissections were included. Univariate and multivariate analyses were conducted to analyze the association between treatment and new or recurrent events and clinical outcome. RESULTS: Mean follow-up was 24.3 months. In patients with spontaneous dissection, 55% received antiplatelets, 29.4% anticoagulation, and 12.6% combined treatment. New or recurrent ischemic and hemorrhagic events occurred in 9.6% of patients on antiplatelets, 10.4% on anticoagulation, and 13.3% on combined treatment. For traumatic dissection, 58.3% received antiplatelets, 26.9% anticoagulation, and 10.2% combined treatment. New or recurrent ischemic and hemorrhagic events occurred in 6.9% on antiplatelets, 11.1% on anticoagulation, and 20% on combined treatment. In patients with intracranial dissection, 63.1% were started on antiplatelets, 19.7% on anticoagulation, and 14.5% on combined treatment. Ischemic and hemorrhagic events occurred in 8.5% on antiplatelet treatment, 15.4% on anticoagulation, and 18.2% on combined treatment. In patients with extracranial dissection, 54.4% were on antiplatelets, 28.9% on anticoagulation, and 11.2% on combined treatment. Ischemic and hemorrhagic events occurred in 10.1% on antiplatelet treatment, 9.3% on anticoagulation, and 13.8% on combined treatment. The association between antithrombotic treatment and ischemic/hemorrhagic events and clinical outcome was not significant for all subtypes of dissection. CONCLUSION: The rate of new or recurrent events is similar with antiplatelet and anticoagulation treatment in treating intracranial and extracranial carotid and vertebral artery dissection.

Carotid and Vertebral Artery Dissection Syndromes.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4145-4145
Author(s):  
Beatriz Grand ◽  
Jorge Solimano ◽  
Adriana Ventura ◽  
Ernesto Quiroga Micheo ◽  
Dardo Riveros
Keyword(s):  
Vertebral Artery ◽  
Clinical Presentation ◽  
Oral Anticoagulants ◽  
Vertebral Artery Dissection ◽  
Clinical Signs ◽  
Young Patients ◽  
Complete Recovery ◽  
Artery Dissection ◽  
Hemorrhagic Complication ◽  
Progressing Stroke

Abstract Objetives: To describe the clinical presentation, diagnosis and treatment of patients with carotid and vertebral artery dissection (CAD, VAD). Design: Retrospective, observational Patients and methods: Clinical recording were evaluated from 1996 to 2005; 6 patients (3 women, 3 men, mean age 37 years) with CAD (3) and VAD (3) were referred to our hematology unit. Clinical presentation: progressing stroke 4/6 and transient ischemic attack (TIA) 2/6; warning sings and symptoms preceding the onset of stroke in 80%. Vascular risk factors included smoking and hypertension; associated features were headache, visual symptoms and Horner’s syndrome; Predisposing factors as physical exercise and trauma were found in 4/6. One patient was at 20 weeks of pregnancy. Diagnosis: Diagnostic tests included: Doppler ultrasound, magnetic resonance imaging (MRI) and angiography (MRA). On admission angiographic studies showed occlusion or stenoses of dissected arteries. Treatment: Anticoagulation with heparin or low molecular weight heparin followed by oral anticoagulants. Outcome: No hemorrhagic complication, no recurrence, complete recovery in 5 patients and mild dysarthria in one. Conclusion: TIA and progressing stroke in young patients are presenting features of CAD and VAD. The diagnosis is based on clinical signs and confirming angiographic investigation. Our experience shows that anticoagulation is the treatment of choice, although controlled studies to show their effectiveness are lacking.

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