Vertebral artery dissection stroke in evolution presented with postural headache as initial manifestation

In young adult, the most common etiology of acute ischemic brain infarction are arterial dissections and cardiogenic embolic stroke. Vertebral artery dissection without preceding trauma history is quite rare in young ischemic stroke patients. Postural headache is even more atypical presentation for vertebral artery dissection. It is often misdiagnosed as spontaneous intracranial hypotension. We described a 37-year-old male suffering from acute onset postural headache with stroke in evolution during hospitalization. The initial brain magnetic resonance imaging (MRI) mislead to diagnosis of ischemic lesion. Nevertheless, with the aid of single photon emission computed tomography, we are confident the patient was afflicted with ischemic/hemorrhagic lesion, instead of neoplasm or demyelinating diseases. Lateral medullary syndrome was confirmed on the repeated brain MRI. His general condition improved with steady gait and clear articulation without easychoking after adequate hydration and rehabilitation training with aspirin as secondary prevention. Cranial artery dissections is a crucial differential diagnosis while thunderclap headache happens even related to postural change without obvious neurological deficit in the beginning presentations.

Download Full-text

Spontaneous Vertebral Artery Dissection and Thrombosis Presenting as Lateral Medullary Syndrome

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0039-1697243 ◽

2019 ◽

Vol 10 (03) ◽

pp. 502-503

Author(s):

Neeraj Kumar ◽

Ravindra Kumar Garg ◽

Hardeep Singh Malhotra ◽

Vivek Lal ◽

Ravi Uniyal ◽

...

Keyword(s):

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Lateral Medullary Syndrome

Download Full-text

Efficacy of high-resolution cone-beam CT in the evaluation of perforators in vertebral artery dissection

Interventional Neuroradiology ◽

10.1177/1591019917706190 ◽

2017 ◽

Vol 23 (4) ◽

pp. 350-356 ◽

Cited By ~ 3

Author(s):

Kenji Shimada ◽

Michihiro Tanaka ◽

Keisuke Kadooka ◽

Hiromu Hadeishi

Keyword(s):

High Resolution ◽

Vertebral Artery ◽

Cone Beam Ct ◽

Vertebral Artery Dissection ◽

Three Dimensional ◽

Major Complication ◽

Cone Beam ◽

Artery Dissection ◽

Ischemic Lesion ◽

Postoperative Mri

Introduction A major complication of internal coil trapping for vertebral artery dissection (VAD) is medullary infarction associated with perforator occlusion. Currently, higher spatial resolution imaging can be obtained with high-resolution cone-beam computed tomography (VASO CT), and the efficacy of perforator visualization adjacent to VAD was examined. Methods Eight patients who underwent internal coil trapping or stent-supported coil embolization underwent VASO CT to evaluate perforators around VAD. Visualization of perforators was compared with conventional digital subtraction angiography (DSA) and three-dimensional rotational angiography (3D-RA). Postoperative MRI was performed in all patients to investigate ischemic complications. The relationship between the perforators and the infarction was analyzed. Results Perforator visualization was much clearer on VASO CT than on 2D DSA or 3D-RA. It was sharp enough to identify each perforating artery. Medullary infarctions were detected in two cases. In these two cases, each ischemic lesion corresponded to the territory of a perforator that was well visualized on VASO CT. The axial view with adjoining tissue structures on VASO CT was useful to detect the territories of perforators. Conclusions VASO CT is an efficient modality for the detection and identification of perforators in the vicinity of VAD. It provides accurate anatomical information about the vertebrobasilar system that is useful for the treatment of unruptured VAD.

Download Full-text

Lateral Medullary Syndrome and Ipsilateral Hemiplegia (Opalski Syndrome) Due to Left Vertebral Artery Dissection

Archives of Neurology ◽

10.1001/archneurol.2009.268 ◽

2009 ◽

Vol 66 (12) ◽

Cited By ~ 12

Author(s):

Jorge García-García ◽

Óscar Ayo-Martín ◽

Tomás Segura

Keyword(s):

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Lateral Medullary Syndrome

Download Full-text

Vertebral artery dissection in term pregnancy after cervical spine manipulation: a case report and review the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-03090-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Francesca Monari ◽

Stefano Busani ◽

Maria Giovanna Imbrogno ◽

Isabella Neri ◽

Massimo Girardis ◽

...

Keyword(s):

Differential Diagnosis ◽

Cervical Spine ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Caucasian Woman ◽

Ischemic Lesion ◽

History Of ◽

Cervical Spine Manipulation ◽

In Pregnancy

Abstract Background Vertebral artery dissection is an uncommon, but potentially fatal, vascular event. This case aimed to describe the pathogenesis and clinical presentation of vertebral artery dissection in a term pregnant patient. Moreover, we focused on the differential diagnosis, reviewing the available evidence. Case presentation A 39-year-old Caucasian woman presented at 38 + 4 weeks of gestation with a short-term history of vertigo, nausea, and vomiting. Symptoms appeared a few days after cervical spine manipulation by an osteopathic specialist. Urgent magnetic resonance imaging of the head was obtained and revealed an ischemic lesion of the right posterolateral portion of the brain bulb. A subsequent computed tomography angiographic scan of the head and neck showed a right vertebral artery dissection. Based on the correlation of the neurological manifestations and imaging findings, a diagnosis of vertebral artery dissection was established. The patient started low-dose acetylsalicylic acid and prophylactic enoxaparin following an urgent cesarean section. Conclusion Vertebral artery dissection is a rare but potential cause of neurologic impairments in pregnancy and during the postpartum period. It should be considered in the differential diagnosis for women who present with headache and/or vertigo. Women with a history of migraines, hypertension, or autoimmune disorders in pregnancy are at higher risk, as well as following cervical spine manipulations. Prompt diagnosis and management of vertebral artery dissection are essential to ensure favorable outcomes.

Download Full-text