scholarly journals Cerebellar infarction after sneezing

2020 ◽  
Vol 66 (10) ◽  
pp. 1351-1354
Author(s):  
Gustavo Bittencourt Camilo ◽  
Marco Antônio Riccio ◽  
Anna Luíza Machado Nogueira ◽  
Amanda Campos Querubino ◽  
Ana Luísa dos Santos Maciel ◽  
...  

SUMMARY Vertebral Artery Dissection (VAD) is a rare condition that can be caused by a wide amplitude of neck movement, which injures the vessel wall and can cause ischemia in the cerebellum. We present a 37-year-old man with herniated lumbar disc and allergic rhinosinusitis, which caused sneezing spells. After one of these bouts with a ricochet of the head, he presented C3 misalignment with local pain. Twenty-one days later, affected by a new crisis, he presented left temporal headache, nystagmus, and vertigo. After 3 days, Magnetic Resonance Imaging (MRI) identified 2 regions of cerebellar ischemia and filling failure of the right vertebral artery. After 2 days, Computed Angiotomography (CT Angiography) was performed and showed right VAD with a local thrombus, without aneurysmal signs. Transcranial Doppler did not indicate an increase in blood flow from this artery. The suggested treatment involved administration of anticoagulant Apixabana 5mg, 12/12h, for 3 months, until the condition was reevaluated with new Angio CT and MRI. It was recommended that the patient was released from work for 1 month and forbidden from doing intense physical exercises for 3 months; however, due to setbacks, these deadlines were extended until a new appointment, 4 months after the first visit. The new tests showed no changes, indicating that the condition was stable. This case aims to indicate the possible investigations of the diagnosis and therapeutic options of the rare association between VAD with cerebellar infarction in a well-documented case.

2016 ◽  
Vol 9 (4) ◽  
pp. e9-e9
Author(s):  
Michael A Silva ◽  
Alfred P See ◽  
Priyank Khandelwal ◽  
Nirav J Patel ◽  
Mohammad Ali Aziz-Sultan

Vertebral artery dissection (VAD) is an important cause of ischemic stroke and subarachnoid hemorrhage (SAH). Dissections presenting with ischemia rarely cause SAH after more than a few hours, especially without radiographic evidence of pseudoaneurysm. We successfully treated a patient for persistent vessel injury presenting with SAH 7 years after presenting with extracranial subocclusive dissection of the right vertebral artery and an associated right posterior inferior cerebellar artery stroke. This is one of only three reported cases of delayed SAH occurring more than 2 weeks after an initial ischemic presentation of a VAD, and the only one without radiographic evidence of pseudoaneurysm at standard follow-up duration.


2001 ◽  
Vol 31 (3) ◽  
pp. 163-166 ◽  
Author(s):  
Jung-Eun Cheon ◽  
I.-O. Kim ◽  
W. S. Kim ◽  
Yong Seung Hwang ◽  
Kyu Chang Wang ◽  
...  

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Katleen Devue ◽  
Annemie Van Ingelgem ◽  
Katrien De Keukeleire ◽  
Marc De Leeuw

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.


2019 ◽  
Vol 10 ◽  
pp. 126
Author(s):  
Kiyoshi Tsuji ◽  
Akira Watanabe ◽  
Nobuhiro Nakagawa ◽  
Amami Kato

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.


2020 ◽  
Vol 79 (1) ◽  
pp. 20-26
Author(s):  
Masahiko Seki ◽  
Kunio Mizutari ◽  
Shin Tadokoro ◽  
Akihiro Shiotani

2019 ◽  
Vol 46 (Suppl_1) ◽  
pp. V13
Author(s):  
Jacob Cherian ◽  
Thomas P. Madaelil ◽  
Frank Tong ◽  
Brian M. Howard ◽  
C. Michael Cawley ◽  
...  

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.


2021 ◽  
pp. 207-209
Author(s):  
Burcu Zeydan ◽  
Orhun H. Kantarci

A 21-year-old woman with baseline depression, 1-year history of recurrent, painful, oral and vaginal ulcers, and cellulitis had a new, severe, acute-onset, left posterior headache with left shoulder pain. On neurologic examination, she had mild right oculomotor and abducens nerve weakness and marked left upper extremity and moderate left lower extremity upper motor neuron–type paresis. Initial brain magnetic resonance imaging showed acute ischemia involving the right pons, right midbrain, right cerebral peduncle, and internal capsule, extending into the right diencephalic region. Neck computed tomography angiography identified a right vertebral artery dissection at the C3 level. Cerebrospinal fluid analysis showed a marked neutrophilic pleocytosis with a reported “high” white blood cell count. HLA-B51 testing was positive. Biopsies of her ulcers indicated nonspecific inflammation with no infectious sources. Her severe headache preceding the manipulations, along with recurrent, painful, oral and genital ulcers (recurrent aphthous stomatitis), cerebrospinal fluid pleocytosis, and brainstem involvement after a vertebral artery dissection, raised concern for Behçet syndrome and eventually neurologic involvement of Behçet syndrome. Recurrent corticosteroid-responsive oral ulcers plus recurrent genital ulcers and skin lesions (cellulitis) fulfill the criteria for Behçet syndrome, with possible neurologic involvement (neuro-Behçet syndrome). The positive HLA-B51 testing was consistent with the diagnosis of Behçet syndrome. Treatment was initiated with low-dose aspirin and intravenous methylprednisolone, after which her neurologic status started to improve. Oral prednisone and azathioprine were added for long-term treatment. At age 25 years, she discontinued azathioprine because she planned pregnancy. At age 27 years, she started having recurrence of oral and genital ulcers, along with axillary ulcerative skin lesions. New-onset diplopia and left-sided weakness also developed before corticosteroid and azathioprine could be reinitiated. Magnetic resonance imaging of the brain showed a new left pontine and cerebellar peduncle lesion with subtle contrast enhancement. Intravenous methylprednisolone was initiated, followed by reinitiation of oral prednisone and the azathioprine regimen for long-term maintenance immunotherapy. The prednisone was slowly tapered after 3 months. The final diagnosis for this patient was relapsing neuro-Behçet syndrome because she had 2 recurrent neurologic episodes associated with 1) vertebral artery dissection and 2) brainstem involvement. If she were to have further relapses, the plan was to administer a tumor necrosis factor-α‎ inhibitor. The case of this patient highlights 3 aspects of Behçet syndrome: 1) diagnosis of systemic Behçet syndrome is made on clinical grounds only, but even if the diagnostic criteria are not fulfilled, once neuro-Behçet syndrome develops, treatment should be initiated to curtail significant morbidity; 2) although rare, arterial involvement in neuro-Behçet syndrome should be recognized; and 3) there are notable sex-dependent factors in the evolution of Behçet syndrome.


2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Tomoki Nakamizo ◽  
Takashi Koide ◽  
Hiromichi Miyazaki

Intracranial vertebral artery dissection (IVAD) is a potentially life-threatening disease, which usually presents with ischemic stroke or subarachnoid hemorrhage. IVAD presenting with isolated facial pain is rare, and no case with isolated trigeminal neuralgia- (TN-) like facial pain has been reported. Here, we report the case of a 57-year-old male with IVAD who presented with acute isolated TN-like facial pain that extended from his left cheek to his left forehead and auricle. He felt a brief stabbing pain when his face was touched in the territory of the first and second divisions of the left trigeminal nerve. There were no other neurological signs. Magnetic resonance imaging (MRI) of the brain 7 days after onset revealed dissection of the left intracranial vertebral artery without brain infarction. The pain gradually disappeared in approximately 6 weeks, and the patient remained asymptomatic thereafter, except for a brief episode of vertigo. Follow-up MRI revealed progressive narrowing of the artery without brain infarction. This case indicates that IVAD can present with isolated facial pain that mimics TN. IVAD should be considered in the differential diagnosis of acute facial pain or TN.


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