Lumbar Subdural Hematoma From Intracranial Subarachnoid Hemorrhage Presenting With Bilateral Foot Drop: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. E835-E839 ◽  
Author(s):  
James S Waldron ◽  
Michael C Oh ◽  
Dean Chou
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Subdural Hematoma ◽  
Vertebral Artery Dissection ◽  
Expectant Management ◽  
External Ventricular Drainage ◽  
Foot Drop ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Modest Improvement

Abstract BACKGROUND AND IMPORTANCE: We report a patient with lumbar subdural hematoma secondary to intracranial subarachnoid hemorrhage (SAH) presenting with bilateral foot drop and describe our management. CLINICAL PRESENTATION: A 37-year-old woman presented with grade 4 SAH and hydrocephalus requiring emergent external ventricular drainage. Angiography demonstrated a left vertebral artery dissection and pseudoaneurysm that was treated with embolization of the vertebral artery. Six days after admission, her neurologic examination significantly improved. She was awake, alert, following commands, and moving all her extremities normally except for bilateral foot drop. An MRI scan revealed a lumbar subdural hematoma with severe thecal sac compression at L4-S1. The patient was initially treated with expectant management followed by surgery after she demonstrated only modest improvement. Evacuation of the hematoma was undertaken by an L5-S1 laminectomy and drainage of the liquefied clot in the subdural, extra-arachnoid space. Postoperatively, the patient demonstrated improved strength in all muscle groups except for left lower extremity eversion. CONCLUSION: We present a case of subdural hematoma that caused bilateral foot drop. Neurologic improvement occured after evacuation of the hematoma.

scholarly journals Combined reconstructive and deconstructive endovascular approach for bilateral vertebral artery dissection with subarachnoid hemorrhage

2019 ◽  
Vol 46 (Suppl_1) ◽  
pp. V13
Author(s):  
Jacob Cherian ◽  
Thomas P. Madaelil ◽  
Frank Tong ◽  
Brian M. Howard ◽  
C. Michael Cawley ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Critical Flow ◽  
Alternative Strategies ◽  
Potential Alternative ◽  
Endovascular Approach ◽  
The Right

The video highlights a challenging case of bilateral vertebral artery dissection presenting with subarachnoid hemorrhage. The patient was found to have a critical flow-limiting stenosis in his dominant right vertebral artery and a ruptured pseudoaneurysm in his left vertebral artery. A single-stage endovascular treatment with stent reconstruction of the right vertebral artery and coil embolization sacrifice of the left side was performed. The case highlights the rationale for treatment and potential alternative strategies.The video can be found here: https://youtu.be/e0U_JE2jISw.

Lethal Vertebral Artery Dissection in Pregnancy: A Case Report and Review of the Literature

2006 ◽  
Vol 130 (4) ◽  
pp. 533-535 ◽  
Author(s):  
Madalina Tuluc ◽  
Daniel Brown ◽  
Bruce Goldman
Keyword(s):  
Case Report ◽  
Pregnant Woman ◽  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Fatal Outcome ◽  
Vertebral Artery Dissection ◽  
Rare Event ◽  
Artery Dissection ◽  
Review Of The Literature ◽  
In Pregnancy

Abstract Subarachnoid hemorrhage represents a rare event in pregnancy with a high mortality rate. We present the case of a 39-year-old pregnant woman who developed right vertebral artery dissection with subsequent massive subarachnoid hemorrhage with fatal outcome. The macroscopic and microscopic autopsy findings are described. A review of the literature with a discussion of the varied predisposing factors for vertebral artery dissection and subarachnoid hemorrhage and the rarity of these events in pregnancy is provided.

scholarly journals A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Katleen Devue ◽  
Annemie Van Ingelgem ◽  
Katrien De Keukeleire ◽  
Marc De Leeuw
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Minor Trauma ◽  
Systemic Thrombolysis ◽  
The Right

This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage: clinical and histopathological investigations from a medicolegal perspective

2009 ◽  
Vol 110 (5) ◽  
pp. 948-954 ◽  
Author(s):  
Ayako Ro ◽  
Norimasa Kageyama ◽  
Nobuyuki Abe ◽  
Akihiro Takatsu ◽  
Tatsushige Fukunaga
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Clinical Features ◽  
Cross Sections ◽  
Fatal Outcome ◽  
Vertebral Artery Dissection ◽  
Clinical History ◽  
Clinical Diagnostics ◽  
Artery Dissection ◽  
Prodromal Symptoms

Object Subarachnoid hemorrhage (SAH) due to a ruptured intracranial vertebral artery (VA) dissection sometimes results in a sudden fatal outcome. The authors analyzed the relationship between clinical features and histopathological characteristics among fatal cases to establish valuable information for clinical diagnostics and prophylaxis. Methods This study included 58 medicolegal autopsy cases of ruptured intracranial VA dissection among 553 fatal nontraumatic cases of SAH that occurred between January 2000 and December 2007. Their clinical features were obtained from autopsy records. Histopathological investigations were performed on cross-sections obtained from all 4-mm segments of whole bilateral intracranial VAs and prepared with H & E and elastica van Gieson staining. Results The autopsy cases included 47 males and 11 females, showing a marked predilection for males. The mean age was 46.8 ± 7.7 years, with 78% of the patients in their 40s or 50s. Hypertension was the most frequently encountered history; it was found in 36% of cases from clinical history and in 55% of cases based on autopsy findings. Prodromal symptoms related to intracranial VA dissections were detected in 43% of patients. Headache or neck pain lasting hours to weeks was a frequent complaint. Of patients with prodromal symptoms, 44% had consulted doctors; however, in none of these was SAH or intracranial VA dissection diagnosed at a preventable stage. Autopsy revealed fusiform aneurysms with medial dissecting hematomas. Apart from ruptured intracranial VA dissection, previous intracranial VA dissection was detected in 25 cases (43%); among them, 10 showed previous dissection of the bilateral intracranial VAs. The incidence of prodromal symptoms (60%) among the patients with previous intracranial VA dissection was significantly higher than that (30%) among cases without previous dissection (chi-square test; p = 0.023). Most previous intracranial VA dissections formed a single lumen resembling nonspecific atherosclerotic lesions, with the exception of 3 cases (12%) with a double lumen. Conclusions Intracranial VA dissection resulting in fatal SAH frequently affects middle-aged men with untreated hypertension. Related to the high frequency of prodromal symptoms, latent previous intracranial VA dissection was histopathologically detected. Furthermore, intracranial VA dissection tends to induce multiple lesions affecting both intracranial VAs recurrently. This suggests the importance of an awareness of sustained whole intracranial VA vulnerability for the prevention of recurrence. The incidence of prodromal symptoms was significantly higher among patients with previous intracranial VA dissections. Thus, earlier diagnosis of intracranial VA dissections at the unruptured stage is desirable for prophylaxis against fatal SAH.

scholarly journals Left vertebral artery dissection causing bilateral internuclear ophthalmoplegia

CJEM ◽  
2008 ◽  
Vol 10 (05) ◽  
pp. 485-487
Author(s):  
Glen Jickling ◽  
Kelvin Leung ◽  
Kenman Gan ◽  
Ashfaq Shuaib ◽  
James Lewis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Clinical Findings ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Internuclear Ophthalmoplegia ◽  
Gradual Improvement ◽  
Brainstem Lesion ◽  
Posterior Neck

ABSTRACT A 21-year-old woman presented to the emergency department 1 day after a fall. On the day of presentation, she awoke with horizontal diplopia and posterior neck pain. Based on clinical findings, she was diagnosed with bilateral internuclear ophthalmoplegia. A conventional angiogram identified a left vertebral artery dissection. She was started on anticoagulant therapy, with gradual improvement of her diplopia over several months. Diplopia is frequently seen in the emergency department. Internuclear ophthalmoplegia is a cause of binocular diplopia and is important to recognize because it indicates a brainstem lesion requiring neurologic evaluation.

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

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.

Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients

2004 ◽  
Vol 101 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Masaru Yamada ◽  
Takao Kitahara ◽  
Akira Kurata ◽  
Kiyotaka Fujii ◽  
Yoshio Miyasaka
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Conservative Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Delayed Diagnosis ◽  
Acute Stage ◽  
Artery Dissection ◽  
Content Type ◽  
String Structure ◽  
Fine Print

Object. Intracranial vertebral artery (VA) dissection with subarachnoid hemorrhage is notorious for frequent rebleeding and a poor prognosis. Nevertheless, some patients survive with a good final outcome. The factors associated with the prognosis of this disease are not fully understood and appropriate treatment strategies continue to be debated. The authors retrospectively evaluated the clinical features of conservatively treated patients to elucidate the relationship between the clinical and angiographic characteristics of the disease and final outcomes. Methods. This study includes 24 patients who were treated by conservative methods between 1990 and 2000. Conservative treatment was chosen because of delayed diagnosis, poor clinical condition, or anatomical features such as bilateral lesions and contralateral VA hypoplasia. Of nine patients with an admission Hunt and Kosnik Grade I or II, eight had good outcomes (mean follow-up period 8 years and 4 months). All 15 patients with Grade III, IV, or V died and in 10 of these the cause of death was rebleeding. Among the 24 patients, 14 suffered a total of 35 rebleeding episodes; in 10 (71.4%) of these 14 patients rebleeding occurred within 6 hours and in 13 (93%) within 24 hours. Compared with the survivors, there was a female preponderance (0.022) among patients who died. These patients also had significantly shorter intervals between onset and hospital admission (p = 0.0067), a higher admission Hunt and Kosnik grade (p = 0.0001), a higher incidence of prehospitalization (p = 0.0296) and postadmission (p = 0.0029) rebleeding episodes, and a higher incidence of angiographically confirmed pearl-and-string structure of the lesion (p = 0.0049). Conclusions. In our series of preselected patients, poor admission neurological grade, rebleeding episode(s), and lesions with a pearl-and-string structure were predictive of poor outcomes. Our findings indicate that patients with these characteristics may be candidates for aggressive attempts to prevent rebleeding during the acute stage. Patients without these characteristics may be good candidates for conservative treatment, especially those who survive the acute phase without rebleeding.

Right Vertebral Artery Transection With a Vertical Distraction of C5-6: Case Report of a Patient Survival

2020 ◽  
Vol 86 (5) ◽  
pp. 531-533
Author(s):  
Jared Griffard ◽  
Reagan Bollig
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Vertebral Artery ◽  
Spinal Cord Injuries ◽  
Patient Survival ◽  
Multidisciplinary Treatment ◽  
Vertebral Artery Dissection ◽  
Spinal Column ◽  
Left Vertebral Artery ◽  
Artery Dissection

Spinal column injuries are very commonly diagnosed in the multitrauma population, and extensive distraction injuries are often fatal due to cerebrovascular injuries or spinal cord injuries. We present a 62-year-old female who presented after an MVC with a 2-cm vertical distraction injury of C5-6 with a right vertebral artery transection and left vertebral artery dissection. She received multidisciplinary treatment which resulted in her survival, albeit with severe neurologic deficits. We challenge the current literature that suggests a blunt vertebral artery transection is 100% fatal.

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