Vertebral Artery Dissection Related to Amphetamine Abuse – A Case Report

We report the case of a 37-year-old male patient with chronic amphetamine abuse who presented with vertebral artery dissection. Prior to presentation, he had increased the consumption of amphetamine from 5 times a year to once every week and had used amphetamine on the day of presentation. He attended with neck pain, vertigo and coordinating difficulties of his left arm. Computed tomography angiogram of the neck vessels showed a left vertebral stenosis and cerebral magnetic resonance imaging showed a left vertebral pseudolumen and a medullary stroke. Cervical artery dissection is a major cause of stroke in the young. To the authors’ knowledge, this is the second reported case of vertebral artery dissection in a patient with amphetamine abuse. Amphetamine might contribute to an increased risk of vertebral artery dissection through its vasculopathic properties although more data are needed to establish a causal relationship.

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Traumatic Vertebral Artery Dissection and Basilar Artery Occlusion/Stroke in a 7-Year-Old Child: A Case Report

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1692670 ◽

2019 ◽

Vol 08 (04) ◽

pp. 233-237

Author(s):

Binh Phung ◽

Trusha Shah

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Basilar Artery ◽

Vertebral Artery Dissection ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Life Threatening ◽

Computed Tomography Angiogram

AbstractVertebral artery dissection (VAD) followed by basilar artery occlusion/stroke (BAO/BAS) is a rare but potentially life-threatening complication. We present a case report of a 7-year-old boy with VAD complicated by BAO/BAS 4 days after falling off a scooter. Symptoms included left-sided weakness and facial droop preceded by a 20-minute episode of altered sensorium. Magnetic resonance imaging showed ischemic changes in the left posterior inferior cerebellum and right pons. Computed tomography angiogram confirmed dissection of the left vertebral artery with occlusion/thrombosis of the basilar artery. Heparinization for 96 hours, followed by 6 months of low-molecular weight heparin injection, resulted in improvement of his neurological symptoms.

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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.

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Postpartum Acute Basilar Artery Occlusion Secondary to Vertebral Artery Dissection. Case Report and Literature Review

The Journal of Critical Care Medicine ◽

10.2478/jccm-2021-0015 ◽

2021 ◽

Vol 7 (4) ◽

pp. 294-301

Author(s):

Iulia-Adela Drăghici ◽

Lucian Marginean ◽

Rares-Cristian Filep ◽

Zoltan Bajko ◽

Laura Barcutean ◽

...

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Relevant Literature ◽

Vertebral Artery Dissection ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Artery Dissection ◽

Mortality And Morbidity ◽

Her Family ◽

Increased Risk

Abstract Female patients in the peripartum and postpartum periods have an increased risk of stroke than nonpregnant women. Cerebrovascular complications of pregnancy represent a significant cause of maternal mortality and morbidity and are potentially disabling. Acute basilar artery occlusion secondary to spontaneous vertebral artery dissection in the postpartum period is an infrequent entity and a major diagnostic and treatment challenge. In the present case, a 37-year-old female patient, eight weeks after caesarean delivery, presented with a history of sudden cervical pain, followed by headache and dizziness. Some hours later, she was found unconscious by her family and was transferred to the emergency department, where a neurological status assessment suggested vertebrobasilar stroke. The imagistic workup revealed right vertebral artery dissection and basilar artery occlusion without constituted ischemic lesions. The patient underwent endovascular intervention with dilation of the narrowed vertebral artery and stent retriever basilar artery thrombectomy, with a favourable clinical outcome. This report first presents the details of this case and the relevant literature data on postpartum arterial dissections and the subsequent ischemic complications and available treatment options.

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Vertebral artery dissection with amphetamine abuse

Journal of Stroke and Cerebrovascular Diseases ◽

10.1053/jscd.2001.20980 ◽

2001 ◽

Vol 10 (1) ◽

pp. 27-29 ◽

Cited By ~ 15

Author(s):

Osama O. Zaidat ◽

Jeffery Frank

Keyword(s):

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Amphetamine Abuse

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Response by Di Meglio et al to Letter Regarding Article, “Intracranial Extension of Extracranial Vertebral Artery Dissection Is Associated With an Increased Risk of Ischemic Events”

Stroke ◽

10.1161/strokeaha.119.027043 ◽

2019 ◽

Vol 50 (11) ◽

Author(s):

Lucas Di Meglio ◽

Mikael Mazighi ◽

Hugues Chabriat

Keyword(s):

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Intracranial Extension ◽

Artery Dissection ◽

Increased Risk ◽

Extracranial Vertebral Artery ◽

Ischemic Events

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Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000200 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Christina Xia ◽

Lee Pfaff ◽

Navreet Kaur ◽

Neil Suryadevara ◽

Hesham Masoud

Keyword(s):

Vertebral Artery ◽

Motor Vehicle ◽

Vertebral Artery Dissection ◽

Clinical Signs ◽

The United States ◽

Homonymous Hemianopia ◽

Artery Dissection ◽

Multiple Chronic Conditions ◽

Cervical Artery Dissection ◽

Patient Reported

Introduction : Traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45. Recent chiropractic neck manipulation is associated with risk of vertebral artery dissection (VAD). The V3 segment of the vertebral artery is highly susceptible to the bending forces during forced manipulation leading to intimal damage. Methods : N/A Results : This is a case presentation of a 44 year old male who was transferred from another emergency department for left homonymous inferior quadrantanopia noted on an optometrist visit. He reported sudden onset left homonymous hemianopia after receiving a high velocity cervical spine adjustment at a chiropractor appointment for chronic neck pain a few days prior. CT angiogram of the head and neck revealed bilateral vertebral artery dissection at left V2 and right V3 segments. MRI brain confirmed an acute infract in the right medial occipital lobe. His right PCA stroke was likely embolic from the injured right V3 but possibly from the left V2 as well. As the patient reported progression from a homonymous hemianopia to a quadrantanopia, he likely had a migrating embolus. Conclusions : Arterial dissection accounts for about 2% of all ischemic strokes, but may be between 8–25% in patients less than 45 years old. VAD can result from trauma of varying severities ‐ from sports, motor vehicle accidents, and chiropractor neck manipulations to violent coughing/sneezing. It is estimated that 1 in 20,000 spinal manipulation results in vertebral artery aneurysm/dissection. In the United States, patients who have multiple chronic conditions are reporting higher use of complementary or alternative medicine, including chiropractic manipulation. Education about the association of VAD and chiropractor maneuvers can be beneficial to the public as these are preventable acute ischemic strokes. In addition, vertebral artery dissection symptoms can be subtle and patients presenting to chiropractors may have distracting pain masking their deficits. Evaluating for appropriateness of cervical manipulation in high‐risk patients and detecting early clinical signs of VAD by chiropractors can be beneficial in preventing acute ischemic strokes in young patients.

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