Magnetic resonance demonstration of vertebral artery dissection

1990 ◽  
Vol 72 (6) ◽  
pp. 964-967 ◽  
Author(s):  
Douglas J. Quint ◽  
Eric M. Spickler
Keyword(s):  
Magnetic Resonance ◽  
Vertebral Artery ◽  
Traumatic Event ◽  
Imaging Modality ◽  
Spin Echo ◽  
Vertebral Artery Dissection ◽  
Invasive Procedure ◽  
Artery Dissection ◽  
Content Type ◽  
Conventional Spin Echo

✓ Vertebral artery dissection may be spontaneous or related to some traumatic event. Diagnosis has usually been made by angiography, an invasive procedure with certain well-known risks. The authors describe the magnetic resonance (MR) appearance (both on conventional spin-echo and on gradient refocused “flow” sequences) in two patients with vertebral artery dissection confirmed by angiography. It is proposed that the less invasive MR imaging might be the imaging modality of choice for initial evaluation of suspected vertebral artery dissection.

scholarly journals Vertebral Artery Dissection Mimicking Migraine: A Case Report

2021 ◽  
Vol 7 (1) ◽  
pp. 21-24
Author(s):  
Rahalkar Kshitij ◽  
◽  
Hong K. Lau ◽  
R Ponampalam ◽  
◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Vertebral Artery ◽  
Thrombus Formation ◽  
Vertebral Artery Dissection ◽  
Vascular Occlusion ◽  
Antiplatelet Agents ◽  
Vascular Wall ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Common Symptom

Vertebral artery dissection (VAD) is caused by an intimal tear that leads to bleeding into the vascular wall, which may cause vascular occlusion by thrombus formation and subsequent distal emboli (leading to ischemic stroke), aneurysm formation and subarachnoid hemorrhage. Cervical artery dissections (either carotid or vertebral artery dissection) are an important cause of stroke in patients under 50-years of age. Headache with or without neck pain is a common symptom. Usually, it occurs with focal neurological signs but sometimes it may occur without any neurological deficits and may mimic migraine. Often it occurs spontaneously without trauma but sometimes there is history of minor traumas, sudden neck movements or chiropractic manipulation. Imaging modalities include magnetic resonance imaging (MRI) brain, magnetic resonance angiography (MRA), and computed tomography angiography (CTA). Treatment involves anticoagulation or antiplatelet agents.

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.

Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography

1994 ◽  
Vol 80 (4) ◽  
pp. 667-674 ◽  
Author(s):  
Chifumi Kitanaka ◽  
Jun-Ichi Tanaki ◽  
Masanori Kuwahara ◽  
Akira Teraoka ◽  
Tomio Sasaki ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Bed Rest ◽  
Arterial Dissection ◽  
Artery Dissection ◽  
Aneurysmal Dilatation ◽  
Content Type ◽  
Brain Stem Ischemia ◽  
Fine Print

✓ The question of whether unruptured intracranial vertebral artery dissections should be treated surgically or nonsurgically still remains unresolved. In this study, six consecutive patients with intracranial vertebral artery dissection presenting with brain-stem ischemia without subarachnoid hemorrhage (SAH) were treated nonsurgically with control of blood pressure and bed rest, and five received follow-up review with serial angiography. No further progression of dissection or associated SAH occurred in any of the cases, and all patients returned to their previous lifestyles. In the serial angiograms in five patients, the findings continued to change during the first few months after onset. Four cases ultimately showed “angiographic cure,” while fusiform aneurysmal dilatation of the affected vessel persisted in one case. In one patient, arterial dissection was visualized on the second angiogram despite negative initial angiographic findings. These results indicate that intracranial vertebral artery dissection presenting without SAH can be treated nonsurgically, with careful angiographic follow-up monitoring. Persistent aneurysmal dilatation as a sequela of arterial dissection seemed to form a subgroup of fusiform aneurysms of the posterior circulation. These aneurysms may be prone to late bleeding and may require surgical treatment.

Repair of a vertebral artery dissection

1986 ◽  
Vol 64 (4) ◽  
pp. 662-665 ◽  
Author(s):  
J. Jeffrey Alexander ◽  
Seymour Glagov ◽  
Christopher K. Zarins
Keyword(s):  
Vertebral Artery ◽  
Surgical Therapy ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Aggressive Approach ◽  
Content Type ◽  
Satisfactory Recovery ◽  
Fine Print

✓ The case is presented of a 38-year-old woman who suffered multiple cerebellar infarctions as a result of emboli from a vertebral artery dissection. Surgical therapy led to a satisfactory recovery. This case emphasizes the importance of an aggressive approach to such lesions.

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