Intramural Hematoma Detection by Susceptibility-Weighted Imaging in Intracranial Vertebral Artery Dissection

Objectives The radiologic diagnosis of vertebral artery dissection (VAD) depends on the characteristic intraluminal findings on angiographic study although the pathology of VAD is intramural hematoma. We aimed to know whether ‘intramural hematoma sign (IHS)’ on susceptibility weighted image (SWI) in vertebral artery is specific for VAD. Methods We retrospectively analyzed SWI and phase map images of the consecutive patients with ischemic stroke in the vertebral artery territory from August 2009 to July 2012. We divided the patients into 2 groups; VAD related stroke and atherosclerotic stroke. Diagnostic criteria of VAD related stroke were (a) presence of posterior neck pain or occipital headache and (b) features of VAD at computed tomography angiography or contrast enhanced magnetic resonance angiography or digital subtraction angiography. Angiographic evidence of VAD which is subdivided into three groups: aneurysmal dilatation without stenosis, pearl-and string, and steno-occlusive without aneurysmal dilatation. IHS was considered positive if the patient had (a) eccentric hypointense signal lesion in vertebro-basilar artery on SWI and (b) this signal should be hyperintense on phase map suggesting blood products other than calcification. An experienced neuroradiologist blinded to clinical information was asked to judge the presence of IHS. For statistical analysis, two by two contingency tables by Fisher’s exact test were performed. Results Among the 137 patients with ischemic stroke in the vertebral artery territory, SWI and phase map images were available in 47 patients who were included for our analysis. Among them, 14 patients were diagnosed as an ischemic stroke due to VAD and 33 patients had no VAD (atherosclerotic stroke). Compared to atherosclerotic stroke patients, patients with VAD-related stroke had more headache (64% vs 15%, P=0.016). Among the 14 patients with VAD-related stroke, IHS was detected in 9 cases while only 2 of 33 patients with atherosclerotic stroke showed IHS (sensitivity 64% and specificity 94%). In Fisher’s exact test analysis, the IHS was significantly associated with VAD (p < 0.001). Conclusion The intramural hematoma sign on SWI was significantly associated with vertebral artery dissection.

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Diffusion-weighted imaging of intramural hematoma in vertebral artery dissection

Journal of the Neurological Sciences ◽

10.1016/j.jns.2006.11.011 ◽

2007 ◽

Vol 253 (1-2) ◽

pp. 81-84 ◽

Cited By ~ 13

Author(s):

Kwang-Dong Choi ◽

Jae-Wook Jo ◽

Kyung-Pil Park ◽

Ji Soo Kim ◽

Tae-Hong Lee ◽

...

Keyword(s):

Vertebral Artery ◽

Diffusion Weighted Imaging ◽

Vertebral Artery Dissection ◽

Intramural Hematoma ◽

Artery Dissection ◽

Diffusion Weighted

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Post-traumatic vertebral artery dissection

10.5327/1516-3180.515 ◽

2021 ◽

Author(s):

Indianara Keila Pastorio ◽

Nayara Christina de Lima Curti ◽

Francine de Paula Roberto Domingos ◽

Sayuri Aparecida Hirayama ◽

Lorena Dias Araújo ◽

...

Keyword(s):

Vertebral Artery ◽

Structural Integrity ◽

Early Recognition ◽

Vertebral Artery Dissection ◽

Intramural Hematoma ◽

Good Prognosis ◽

Cervical Region ◽

Artery Dissection ◽

Minor Trauma ◽

Presenting Symptoms

Introduction: Vertebral artery dissections are responsible for 2% of all ischemic strokes and correspond to more than 25% of events in young adults. Its main etiologies, such as spontaneous and traumatic, which compromise the structural integrity of the arterial wall, allowing blood to accumulate between the layers of the vessel as an intramural hematoma, which can progress to stenosis or luminal occlusion in stroke. Case report: We attended a woman, 29 years old, who suffered a mild trauma in the cervical region during weight training in the gym presenting symptoms hours after the accident, a sudden headache of strong intensity irradiated to cervical, which evolves to a picture of cerebral ischemia characterized by changes in balance and coordination. The diagnosis was confirmed through complementary examinations of cranial tomography and angiotomography and treatment was composed by a combination of aspirin and clopidogrel with favorable evolution of the condition. Conclusion: The report illustrates that the change in cerebral circulation due to ischemia can occur either suddenly or even days after the injury, and it is likely that many cases classified as “spontaneous” without identifying the cause, may have been caused by minor trauma. In general, there is a good prognosis if early recognition and correct management.

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A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery

Journal of Neurosurgery ◽

10.3171/jns.1991.75.6.0874 ◽

1991 ◽

Vol 75 (6) ◽

pp. 874-882 ◽

Cited By ~ 192

Author(s):

Osamu Sasaki ◽

Hiroshi Ogawa ◽

Tetsuo Koike ◽

Takayuki Koizumi ◽

Ryuichi Tanaka

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Arterial Wall ◽

Vertebral Artery Dissection ◽

Intramural Hematoma ◽

Artery Dissection ◽

Content Type ◽

Causative Factors ◽

Dissecting Aneurysms ◽

Vertebral Dissection

✓ Five autopsied cases of dissecting aneurysms of the intracranial vertebral artery are reported and the literature is reviewed to clarify the clinicopathological correlations. In an autopsy series of 110 patients with subarachnoid hemorrhage (SAH), the incidence of this entity was 4.5%, with all five cases progressing rapidly to death from massive SAH. Cases of intracranial vertebral dissection can be divided clearly into two groups based on the clinical and pathological features. In the first group, the dissection is confined to the vertebral artery and a massive SAH develops caused by the rupture of the arterial wall. The plane of dissection is mainly subadventitial. In the second group, brain-stem infarction develops resulting from luminal occlusion by intramural hematoma. The plane of dissection is mainly subintimal, with the dissection extending to the basilar artery. The condition in the second group affects patients at a younger age. If the lesion is localized within the vertebral artery and does not extend to the basilar artery, the disease seems not to be fatal. The clinical features of the vertebral dissection are largely determined by the plane and extension of dissection. Vertebral artery dissection is due to many causative factors including hypertension, congenital or degenerative changes in the arterial wall, and anatomical and pathological characteristics of the vertebral artery.

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