Cesarean Hysterectomy in a Parturient With Morbidly Adherent Placenta Complicated by Postoperative Ischemic Stroke Secondary to Vertebral Artery Dissection

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.

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Vertebral Artery Dissection in a 7-year-old girl: A case report, pictorial review, and review of literature

Journal of Clinical Review & Case Reports ◽

10.33140/jcrc.05.09.07 ◽

2020 ◽

Vol 5 (9) ◽

Keyword(s):

Ischemic Stroke ◽

Case Report ◽

Vertebral Artery ◽

Pediatric Population ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Review Of Literature ◽

Arterial Ischemic Stroke ◽

Pictorial Review ◽

Imaging Recommendations

Vertebral artery dissection (VAD) is a not uncommon cause of arterial ischemic stroke in the pediatric population. Though it is frequently overlooked, and resources help in diagnosis often a concern, the establishment of diagnostic criteria is very crucial for treatment and prognosis. Here, we present a case of VAD with a pictorial and literature review, in addition to imaging recommendations.

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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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Abstract WP231: Detection of Intramural Hematoma by Susceptibility Weighted Image in Vertebral Artery Dissection

Stroke ◽

10.1161/str.44.suppl_1.awp231 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Tae-Won Kim ◽

Jaseong Koo ◽

Hyun Seok Choi ◽

Kwang Soo Lee ◽

Si Baek Lee

Keyword(s):

Ischemic Stroke ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Intramural Hematoma ◽

Artery Dissection ◽

Aneurysmal Dilatation ◽

Exact Test ◽

Weighted Image ◽

Susceptibility Weighted Image ◽

Phase Map

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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