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Results for “Vertebral Artery Dissection”

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PubMed1996

Vertebral artery dissection: issues in diagnosis and management.

Vertebral artery dissection is an uncommon cause of stroke in children. Accuracy of diagnosis by magnetic resonance angiography (MRA) instead of invasive transfemoral angiography (TFA) has been controversial. The need for anticoagulation and duration of such therapy is also arguable. We report 2 boys with vertebral artery dissection: one, aged 7 years, presented with hemiparesis and seizures and the other, aged 4 years, presented with ataxia. Each boy's initial MRA was not interpreted as delineating occlusive lesions to explain the posterior circulation infarcts visualized on computed tomography and magnetic resonance imaging scans. However, subsequent MRAs were suspicious for vertebral artery dissection, which was confirmed by TFA. Both children were treated with anticoagulation therapy. The first patient continued to manifest evidence of new infarcts despite treatment (initially with aspirin alone, followed by anticoagulation with heparin and warfarin), and is now maintained on a combination of high dose warfarin and aspirin. The second patient is now maintained on aspirin alone after initial anticoagulation for 6 months with heparin followed by warfarin. A high index of suspicion for vertebral artery dissection may allow diagnosis on the basis of MRA alone. Previous reports have indicated good outcomes of vertebral artery dissection in children and adults irrespective of anticoagulation treatment. Our experience suggests that anticoagulation may be beneficial in preventing further strokes caused by the dissection.

Aortic Dissection↗

PubMed1998

Stroke following vertebral artery dissection: a case study.

Vertebral artery dissection is an extremely rare but serious precursor to stroke. A case study illustrates how accurate early assessment and diagnosis can permit prompt intervention. Favorable treatment outcomes can occur when such astute management takes place.

Aortic Dissection↗

PubMed2003

Stent-within-a-stent technique for the treatment of dissecting vertebral artery aneurysms.

Subarachnoid hemorrhage from dissecting vertebral artery aneurysms is a well-known phenomenon. With the advent of navigable intracranial stents, these aneurysms are now amenable to endovascular stent placement. However, immediate aneurysm obliteration is often not accomplished, and current covered stents have poor short-term patency rates. We report a series of three patients with intradural dissecting vertebral artery aneurysms treated with a novel endovascular stent-within-a-stent construct using currently available stent technology.

Angioplasty↗

PubMed2006

Comparison of spontaneous intracranial vertebral artery dissection with large artery disease.

OBJECTIVE: To compare clinical and angiographic characteristics and stroke patterns between spontaneous intracranial vertebral artery dissection (VAD) and vertebral large artery disease (LAD) (atherosclerosis). DESIGN: Retrospective study. SETTING: Tertiary referral center for cerebrovascular diseases. Patients Twenty-two patients with spontaneous VAD and 25 with LAD in the intracranial portion of the vertebral artery. MAIN OUTCOME MEASURES: We compared (1) clinical characteristics, including epidemiologic data, vascular risk factors including inflammatory markers, the presence of headache, and stroke syndromes and severity; (2) stroke pattern on diffusion-weighted imaging, which was classified as vertebral perforator infarct, basilar perforator infarct, small scattered infarct, large scattered infarct, and territorial infarct; and (3) angiographic findings, ie, the distribution of involved arteries, degree of stenosis, and the involvement on the anterior circulation and calcification of vertebral artery. RESULTS: Although patients with VAD were younger, and more often had headaches and fewer vascular risk factors than those with LAD (P<.01 in all cases), these clinical features were also observed in some LAD patients. Diffusion-weighted imaging data showed that vertebral perforator infarct and small scattered infarct were most common in the VAD group, while territorial infarct and large scattered infarct were most common in the LAD group (P = .02). On angiography, LAD more frequently had anterior circulation arterial involvement (P = .002), higher degree of stenosis (P = .002), and calcifications (P = .008). CONCLUSION: Our findings indicate that results of diffusion-weighted imaging and noninvasive vascular studies might provide clues to the clinical characteristics in differential diagnosis between VAD and LAD.

Aged↗

PubMed2000

Recognizing vertebral artery dissection in children: a case report.

Vertebral artery dissection is an unusual cause of stroke especially in children. The majority of dissections are thought to be caused by trauma although in many cases the trauma may be trivial. In other cases, certain underlying pathological processes are thought to be risk factors. We report a case of vertebral artery dissection in a 9-year-old child who presented with neurologic deficits suggestive of a posterior circulation stroke. The signs and symptoms of this unusual entity can be subtle and intermittent over a period of days to weeks; thus, making it very difficult to recognize. Therefore, it is important to consider the possibility of vertebral artery dissection in the differential diagnosis of neurologic deficits in children.

Cerebral Infarction↗

PubMed2004

[Complete resolution of radiculopathy due to cervical vertebral artery dissection after intravascular treatment: a case report].

The authors report the case of a rare manifestation by vertebral artery dissection. A 15-year-old boy who presented with left shoulder weakness and numbness of the left arm was admitted to our hospital. Neurological examination on admission revealed muscle weakness of the left deltoid muscle and sensory disturbance of the left C5 area. MRI/MRA and 3D-CT angiography demonstrated an aneurysm-like dilatation of the left vertebral artery mainly at the C4/5 level. Partial thrombosis was noted in the dilated artery. The left vertebral angiogram showed that the second and third portions of the left vertebral artery had a dilated pseudo-lumen due to arterial dissection. The pseudo-lumen of the dissected vertebral artery was largest in diameter at the C4/5 level. The patient successfully underwent proximal occlusion of the dissected vertebral artery using detachable balloon and Guglielmi detachable coils. Proximal vertebral artery occlusion using an intravascular technique was regarded as a non-invasive and effective option for patients with a cervical radiculopathy due to cervical vertebral artery dissection.

Adolescent↗

PubMed2005

Endovascular management of intracranial vertebral artery dissecting aneurysms.

OBJECT: Intracranial vertebral artery (VA) dissecting aneurysms often present with severe subarachnoid hemorrhage (SAH) and dramatic neurological injury. The authors reviewed the management of 23 cases in an effort to evaluate treatment efficacy and outcomes. METHODS: The records of 23 patients who underwent endovascular treatment were reviewed to determine symptoms, type of therapy, complications, and clinical outcomes. All patients were evaluated using records kept in a prospectively maintained database. Ten men and 13 women (age range 35-72 years; mean age 49 years) were treated over an 8-year period. Twelve patients presented with poor-grade SAH, five with good-grade SAH, three with headache, and two with stroke. The other patient's aneurysm was discovered incidentally. Treatment included coil occlusion of the artery at the aneurysm in 21 patients and stent-assisted coil placement in two. Parent artery sacrifice was successful in all cases, whereas both patients treated with stent-assisted coil insertion suffered recurrences. No patient sustained permanent complications as a result of treatment. Two patients died due to the severity of their original SAH. Findings were normal in 14 patients on follow-up review (including five of the 12 presenting with poor-grade SAH), five had fixed neurological deficits but were able to care for themselves, and one was permanently disabled. CONCLUSIONS: Despite their often aggressive neurological presentation, intracranial VA dissecting aneurysms can be managed safely with coil occlusion of the lesion and/or parent artery. Even patients presenting in poor neurological condition may improve dramatically.

Adult↗

PubMedDate not supplied

Vertebral artery dissection due to minor neck trauma.

Vertebral artery dissection has been previously reported following minor head and neck trauma. Such activities as rapid head turning, tennis, yoga, and vigorous exercise have been implicated. We report a case of vertebral artery dissection following minor neck trauma suffered in a volleyball game. The anatomy of the vertebral artery, pathophysiology of dissection, and emergency department recognition and treatment of this disorder are discussed.

Adult↗

PubMed1992

Vertebral artery dissection from neck flexion during paroxysmal coughing.

Vertebral artery dissection has a characteristic presentation that should be considered when symptoms are preceded by any trauma that causes neck movement. We present the case of a man with vertebral artery dissection following severe coughing that presented as a postero-inferior cerebellar artery territory stroke. The patient was anti-coagulated, and his neurologic deficits were partially resolved. The mechanism and presentation of vertebral artery dissection are discussed with an emphasis on early detection.

Adult↗

PubMed2000

The treatment of spontaneous carotid and vertebral artery dissections.

Spontaneous dissections of the carotid and vertebral arteries in the neck are a common cause of stroke in young and middle-aged people. Moreover, they are increasingly recognized as the cause of a wide variety of other, more subtle, neurologic signs and symptoms. The cause of these arterial dissections largely remains unexplained but probably involves a combination of genetic and environmental factors. Magnetic resonance imaging has largely surpassed angiography as the imaging study of choice. The treatment of carotid and vertebral artery dissections is based on rather incomplete evidence. Anticoagulation with heparin followed by warfarin remains the treatment of choice in most major medical centers and is supported by the demonstration of emboli as the most common cause of stroke in these patients. The burgeoning interest in endovascular techniques has resulted in many patients being treated for carotid and vertebral artery dissections with percutaneous angioplasty and stent deployment. Although the treatment of dissections is generally well tolerated and the radiographic results are impressive, most dissections heal spontaneously and the associated aneurysms never rupture and rarely cause delayed ischemic symptoms. Surgical treatment of dissections, consisting of an in situ interposition graft or extracranial-intracranial bypass, is indicated only for those patients with persistent symptoms refractory to maximal medical therapy who are not candidates for endovascular treatment.

Angioplasty, Balloon↗

PubMed2004

More than a pain in the neck: vertebral artery dissection and subarachnoid hemorrhage.

Intracranial vertebral artery dissection is an uncommon but important cause of subarachnoid hemorrhage. These patients have a predilection for early rebleeding that makes early diagnosis and intervention imperative. The arterial dissection and associated dissecting aneurysm are often located close to the origin of the posterior-inferior cerebellar artery. Endovascular treatment techniques have been increasingly employed. An illustrative case that was treated successfully with coils but complicated by a posterior-inferior cerebellar artery territory infarction is presented. The objectives are to highlight the clinical features of this condition and to describe the problems associated with treatment, particularly those related to the posterior-inferior cerebellar artery origin.

Embolization, Therapeutic↗

PubMed1994

Headache and neck pain: the warning symptoms of vertebral artery dissection.

The clinical features of headache and neck pain in 14 patients with extracranial vertebral artery dissection proven by angiography or magnetic resonance imaging are reported. Pain was always located on the side of the dissected vertebral artery. Whereas eleven patients had head and posterior neck pain, the others had either only posterior neck pain, no change of a chronic pre-existing headache or no pain at all. Pain started suddenly, was of sharp quality and severe intensity, different from any previously experienced headache. Following acute onset, the time course of pain was monophasic with gradual remission of a persistent headache lasting one to three weeks. A delay between onset of head or posterior neck pain and onset of neurologic dysfunction was noted in 12 patients and was less than one day and between one day and three weeks in six each. Report of this distinct type of pain, although nonspecific as an isolated symptom, should raise suspicion of an underlying vertebral artery dissection. Early confirmation of this diagnosis and subsequent anticoagulation if dissection does not extend intracranially may help prevent vertebrobasilar ischemic deficits.

Adult↗

PubMed1999

Bilateral vertebral artery dissection causing a cerebrovascular accident in pregnancy. A case report.

BACKGROUND: Vertebral artery dissection, occurring spontaneously or following a traumatic event, is a cause of posterior circulation stroke in young individuals, including pregnant women. CASE: A 20-year-old, primagravid woman acutely developed headache, right-sided hemiparesis and parasthesias, and blurred vision. Within days she complained of cervical neck pain. Magnetic resonance imaging findings were consistent with a posterior circulation cerebrovascular accident (CVA). An arteriogram, performed to exclude vasculitis, revealed bilateral vertebral artery dissection. No inciting event could be recalled. CONCLUSION: Vascular dissections occur rarely during pregnancy. Spontaneous extracranial vertebral artery dissection itself is very rare in general. Cerebral ischemia can follow vertebral artery dissection. In young patients with CVA, consideration of the diagnosis of vertebral artery dissection followed-by angiography and anticoagulation is an important component of the workup and care.

Adult↗

PubMed2000

Spinal manifestations of vertebral artery dissection.

Among 111 patients with vertebral artery dissection (VAD), two presented with spinal manifestations: one with a C5-C6 radiculopathy and the other with a cervical myelopathy. Of 13 previously reported cases of spinal manifestations of VAD (mean age 37 years), ischemic cervical myelopathy was noted in seven; cervical radiculopathy, often at C5-C6 and primarily motor, in five; and hemorrhagic complications in one, with chest pain being part of the presentation.

Adult↗

PubMed1997

Tissue plasminogen activator in a vertebral artery dissection.

BACKGROUND: Spontaneous dissection of the vertebral artery is uncommon. METHOD: Case study. RESULTS: We report a 49-year-old woman who presented with the rapidly progressing basilar artery syndrome who was given an intravenous dose of tissue plasminogen activator seven hours after the onset of first symptoms. Thirty minutes after the injection, a dramatic recovery of the patient's consciousness and neurological signs was noted. CONCLUSION: To our knowledge, this is the first reported case of intravenous tissue plasminogen activator use in acute vertebral artery dissection.

Arterial Occlusive Diseases↗

PubMed1997

Cerebellar infarction from a traumatic vertebral artery dissection in a child.

Infarction due to vertebral dissection is a rarely reported event in children. We describe the clinical presentation, radiological findings and surgical treatment of a child with cerebellar infarction resulting from a traumatic vertebral artery dissection. Review of the literature on stroke due to a vertebral artery dissection in the pediatric population shows that trauma is a common preceding event. Although the most common site of traumatic vertebral artery dissection is at C1-2 level, our case illustrates that the vertebral artery dissection may also involve the lower cervical segment. We emphasize that vertebral artery dissection should be considered in a child with acute symptoms and signs of posterior circulation ischemia and that MRI and MR angiography may be helpful in the diagnosis of infarction and vertebral artery dissection.

Acute Disease↗

PubMedDate not supplied

Extracranial vertebral artery dissections: a review of 13 cases.

Clinical and radiologic findings in 13 patients (11 women, 2 men) with extracranial vertebral artery dissection are reported. Dissection was spontaneous in 8 patients, occurred after neck manipulation in 2 and after a potential minor injury to the neck in 3. Six had a history of common migraine, 4 were using oral contraceptives at the time of dissection, and 3 had fibromuscular dysplasia. Dissection was bilateral in 8 patients and associated with carotid dissection in 3. It usually presented with neck or occipital pain preceding basilar ischemic symptoms by a few minutes to 1 month. In 3 patients, transient ischemic attacks were the only manifestation of basilar ischemia, and in 1 patient there was no symptom of basilar ischemia despite bilateral vertebral dissection. In 19 of the 21 dissected vertebral arteries, the angiographic appearance was that of an irregular stenosis, which was associated in 6 arteries with pseudoaneurysmal formation. In 2 patients, 1 vertebral artery was occluded but the contralateral artery showed the typical irregular stenosis. The dissection involved only the third segment in 33%, only the second segment in 24%, and 2 or more segments in 38%. Eleven patients were treated with anticoagulants and 2 with aspirin; 11 recovered without sequelae and 2 had residual deficit. No recurrence was observed (mean follow-up 34 months). At control angiography (n = 12) or ultrasonic study (n = 1), 63% of dissected vertebral arteries had returned to normal, 26% showed marked improvement, and 11% were occluded. Our patient characteristics are compared with those of previously published cases. The validity of the distinction between spontaneous dissection and dissection associated with minor trauma is discussed.

Adult↗

PubMed2003

Perfusion- and diffusion-weighted MR imaging-guided therapy of vertebral artery dissection: intraarterial thrombolysis through an occipital vertebral anastomosis.

Management of arterial dissections can be particularly challenging. We report a case of vertebral artery dissection in which perfusion- and diffusion-weighted MR imaging findings suggested the presence of salvageable tissue, despite that the patient had symptoms for more than 40 hours. Direct access to the distal vascular territory was unattainable, and the presence of collateral circulation through an occipital vertebral anastomosis provided the only pathway to administer intraarterial thrombolysis. This case demonstrates that perfusion- and diffusion-weighted MR imaging can be instrumental in the selection of candidates for aggressive stroke therapy. Arterial anastomoses can provide alternate access to ischemic vascular beds and merit careful evaluation during intraarterial thrombolysis.

Acute Disease↗