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Results for “Vertebral Artery Dissection”

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PubMed1994

Ophthalmic manifestations of vertebral artery dissection. Patients seen at the Mayo Clinic from 1976 to 1992.

PURPOSE: To determine the ophthalmic manifestations of vertebral artery dissections. METHODS: Fifty-one separate episodes of vertebral artery dissections evaluated at the Mayo Clinic from 1976 through 1992 were studied. In all cases, the diagnosis had been documented with angiography. RESULTS: There were 28 men and 19 women (mean and median age, 39 and 40 years, respectively; range, 8-61 years). There were ophthalmic findings in 86% of the episodes. Visual symptoms, in decreasing order of frequency, were diplopia (45% of the episodes), blurred vision (14%), transient visual dimming (8%), oscillopsia (4%), photophobia (4%), upside-down vision (2%), positional transient visual obscuration (2%), and unilateral dry eye (2%). Ophthalmic signs in decreasing order of frequency were nystagmus (37% of the episodes), ocular misalignment (cranial nerve palsy or skew) (33%), Horner syndrome (27%), decreased corneal sensation (22%), ptosis (16%), visual field defect (10%), abnormal pursuits and saccades (6%), ocular bobbing (4%), internuclear ophthalmoplegia (4%), anisocoria (4%), and pinpoint pupils (2%). CONCLUSION: Vertebral artery dissections occur in a relatively young population. Most of the patients in our study had ophthalmic manifestations at the time of diagnosis. Heightened awareness of this entity should enable the consulting ophthalmologist to have a role in the diagnosis and treatment of vertebral artery dissection.

Adolescent↗

PubMed2000

Coil embolisation for ruptured vertebral artery dissection distal to the origin of the posterior inferior cerebellar artery.

Although many surgical or endovascular treatments for ruptured vertebral artery dissection have been reported, the best treatment is controversial. We treated five cases of ruptured vertebral artery dissection distal to the origin of the posterior inferior cerebellar artery (PICA), using retrievable platinum coils packed in the dissection site and the immediately proximal vertebral artery. All patients had a contralateral vertebral artery of the same calibre or larger. All dissections were occluded completely, together with the portion of the vertebral artery distal to the PICA origin. No complications related to the procedure were seen. The purpose of the treatment is to isolate the dissection from the cerebral circulation. Occlusion of the rupture site, preserving perforating arteries arising from the vertebral artery, would be ideal. Short-segment occlusion by retrievable platinum coils is close to the ideal.

Aged↗

PubMed2005

Atraumatic vertebral artery dissection after cervical corpectomy: a traction injury?

STUDY DESIGN: Case report with review of the literature. OBJECTIVES: Presented is the first case of vertebral artery dissection secondary to intraoperative traction in cervical spine surgery. The pathogenesis and management of vertebral dissection in the immediate postoperative period are reviewed in detail. SUMMARY OF BACKGROUND DATA: Vertebral artery dissection is commonly associated with direct trauma, atraumatic or spontaneous. There are numerous reports of direct injury to the vertebral artery with cervical spine surgery, and it is a well-recognized risk. Cervical traction is also used routinely for improved placement of intervertebral devices/grafts. This is the first report of vertebral artery dissection occurring intraoperatively secondary to traction. The postoperative management is reviewed in detail. METHODS: Case study with extensive review of the literature. RESULTS: The patient underwent C6 corpectomy without intraoperative complications. Intraoperative wake-up test was normal. The patient remained intubated overnight for airway precautions. On postoperative day 1, the patient was lethargic and not following commands. Emergent CT of the brain and cervical spine revealed multiple posterior circulation infarcts with normal cervical spine and no hematoma. A stat angiogram revealed vertebral dissection. Medical management was initially attempted; however, infarcts continued, eventually requiring posterior fossa craniectomy/decompression and sacrificing the vertebral at the O-A junction. CONCLUSIONS: This is the first report of vertebral artery dissection occurring secondary to traction in cervical spine surgery. Surgeons must be aware that traction, even when performed appropriately, is not without risks. Anomalous vertebral arteries, osteophytes, and numerous other anatomic variants can lead to vertebral injury with traction.

Cervical Vertebrae↗

PubMed2000

Subarachnoid hemorrhage from vertebral artery dissecting aneurysms involving the origin of the posteroinferior cerebellar artery: report of two cases and review of the literature.

OBJECTIVE AND IMPORTANCE: Few reports have been published on ruptured vertebral artery dissecting aneurysms in which the posteroinferior cerebellar artery (PICA) arises from the aneurysm wall, and there is ongoing debate as to the proper management of this type of aneurysm. This article describes two patients. CLINICAL PRESENTATION: Both patients presented with subarachnoid hemorrhage and were admitted to our institution on the day of rupture. Computed tomography revealed that the subarachnoid hemorrhage was located mainly in the posterior fossa. Cerebral angiography demonstrated a vertebral dissecting aneurysm involving the origin of the PICA. In one patient, the PICA was very large. INTERVENTION: One patient was treated by trapping, with the PICA involved in the trapped segment. Postoperatively, the patient experienced transient mild hoarseness and dysphasia but recovered completely. The other patient, whose PICA was very large, was initially treated by endovascular proximal occlusion. This resulted in marked enlargement of the distal part of the aneurysm, indicating a need for surgical treatment. A clip was applied to the origin of the PICA after anastomosis of the occipital artery to the PICA. The patient recovered well and was discharged with no neurological deficits. CONCLUSION: The ideal method of treatment for patients with dissecting aneurysms of the vertebral artery involving the PICA origin is complete isolation of the aneurysm by trapping, with revascularization of the PICA. However, trapping alone is one possible treatment option. If proximal clipping alone is carried out, follow-up angiography is mandatory to observe any changes in the aneurysm.

Adult↗

PubMed1994

Extracranial-intracranial saphenous vein bypass for carotid or vertebral artery dissections: a report of six cases.

The management of carotid or vertebral artery dissections has generally been either conservative (with anticoagulation) or surgical (by proximal ligation or trapping procedures). However, identification and management of those patients with a high risk of stroke recurrence have been difficult. Six patients with carotid or vertebral artery dissections underwent a total of seven surgical procedures involving intracranial interpositional saphenous vein bypass grafts anastomosed distally beyond the point of dissection with trapping of the intermediate diseased section of the artery. It is suggested that this procedure be used in patients who have bilateral carotid or vertebral artery disease, persistent angiographic abnormalities (particularly aneurysms), or recurring ischemic events while undergoing anticoagulation therapy, or in whom anticoagulation is undesirable. This procedure has benefits over current surgical options because of the maintenance of high flow, the avoidance of abnormal watershed areas of flow, and the elimination of the risk of emboli. The procedure is compared to previous techniques of extracranial-intracranial bypass.

Adult↗

PubMed1996

[Eight cases of extracranial vertebral artery dissection].

We present eight cases of extracranial vertebral artery dissection. One of these had traumatic antecedents at the neck level while undergoing massage treatment. Of the rest, in four cases there was only a history of commonplace traumatism at neck level, consisting of twisting or stretching. Most presented pain at this level both before and during symptoms. Five had symptoms compatible with lateral bulbar infarct, two with cerebral infarct and one at the protuberance level. Angiography showed irregular stenosis of the spine on the affected side in five cases, occlusion in three cases. Nuclear magnetic resonance (NMR) was performed on five, with findings compatible with dissection. Six received anticoagulant treatment and two received platelet antiagregants with good recovery except in one patient who died twelve months later without any indication of the existence of dissection. We also carried out a review of the literature with special emphasis on the etiology of spontaneous cases, on clinical and neuroimaging findings and on treatment.

Adult↗

PubMed1995

Headache and neck pain in spontaneous internal carotid and vertebral artery dissections.

We studied the characteristics of headaches in 161 consecutive symptomatic patients with spontaneous dissections of the internal carotid artery (n = 135) or the vertebral artery (n = 26). For patients with internal carotid artery dissection (ICAD), the mean age was 47 years and for those with vertebral artery dissection (VAD), 40.7 years. A history of migraine was present in 18% of the ICAD group and in 23% of the VAD group. Headache was reported by 68% of the patients with ICAD and by 69% of those with VAD, and, when present, it was the initial manifestation in 47% of those with ICAD and in 33% of those with VAD. Ten percent of patients with ICAD had eye, facial, or ear pain without headache. The median interval from onset of headache to development of other neurologic manifestations was 4 days for the ICAD group and 14.5 hours for the VAD group. For all dissections, headaches typically were ipsilateral to the side of dissection. In the ICAD group, headaches were limited to the anterior head in 60% of patients and were steady in 73% and pulsating in 25%. In the VAD group, headaches were distributed posteriorly in 83% of patients and were steady in 56% and pulsating in 44%. Neck pain was present in 26% of patients with ICAD (anterolateral) and in 46% of those with VAD (posterior). The median duration of the headache in patients with VAD and ICAD was 72 hours, but headaches became prolonged, persisting for months to years, in four patients with ICAD.

Adult↗

PubMed2006

Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling.

BACKGROUND AND PURPOSE: Endovascular treatment with stent placement or stent-assisted coiling was recently introduced as an alternative to parent artery occlusion in intracranial vertebral artery dissections. We describe the efficacy and limitations of this method. METHODS: Fourteen patients with intracranial vertebral artery dissection were treated with stent placement (10 patients) or stent-assisted coiling (4 patients). Double overlapping stents were deployed in 4 of 10 patients with stent placement alone. Angiographic follow-up at 6 to 12 months was available in 13 patients. RESULTS: In 13 patients with dissecting aneurysm, immediate angiographic outcomes were complete occlusion (1 patient), nearly complete (2 patients), and incomplete (10 patients). Follow-up angiograms of 12 of these patients showed complete occlusion (6 patients) and incomplete (6 patients; 1 unstable and 5 stable). Complete occlusion rates in follow-up angiograms were superior in double stent placement (75%) or stent-assisted Guglielmi detachable coil (GDC) embolization to stent placement alone (0%). There were no instances of postprocedural ischemic attacks, new neurologic deficits, and no new minor or major strokes before patient discharge. On the modified Rankin scale applied in follow-up, all patients were assessed as functionally improved or of stable clinical status. CONCLUSIONS: Intracranial vertebral artery dissections were acceptably treated with stent placement or stent-assisted coiling, and the patency could be preserved at follow-up. However, the efficiency of stent placement alone for intracranial vertebral artery dissecting aneurysm was limited. Stent-assisted coil embolization or double stent placements are a viable alternative for complete occlusion of dissecting aneurysms.

Adult↗

PubMed2004

Treatment of vertebral artery dissecting aneurysms presenting with progressive myelopathy.

Two patients with vertebral artery dissecting aneurysm are presented in which the posterior inferior cerebellar artery (PICA) arose from the wall of the aneurysm. The patients presented with progressive myelopathy due to mass effect on the medulla. One patient was treated with proximal occlusion of the vertebral artery using Guglielmi detachable coils (GDCs). The other patient underwent complete excision of the aneurysm, with reimplantation of the PICA into the vertebral artery proximal to the dissecting aneurysm. We obtained good results with improvement of myelopathy in both patients, but the patient who underwent bypass surgery suffered longstanding palsy of the lower cranial nerves. This report emphasizes that complete aneurysm clipping or excision for such patients is the gold standard of treatment, but preservation of PICA flow may require technically sophisticated surgical techniques. However, even if the aneurysm is not completely eliminated, the myelopathy can be dramatically improved with conservative endovascular treatment with proximal occlusion. Therefore, the choices for treatment in such lesions varies with the angiographic findings, degrees of mass effect on the brainstem, and the patient's physical condition.

Adult↗

PubMed1992

[Wallenberg's syndrome due to vertebral artery dissection following minimal neck injury--report of two cases].

We described two cases of the lateral medullary syndrome (Wallenberg's syndrome) due to vertebral artery dissection following minimal neck injuries. The first case was a 45-year-old man, who hit his head and often rotated his head because of posterior neck discomfort. Two years after the injury, he suffered from sudden sharp neck pain, nausea, and vertigo, which was followed by left hand numbness and difficulty in walking due to the right lateral medullary syndrome. Angiography showed right vertebral artery dissection at the fourth segment. The second case, a 48-year-old man, suffered from neck pain immediately after he hyperextended his neck for painting a wall. Within several hours, he experienced left hand numbness and difficulty in walking due to the lateral medullary syndrome. Angiography showed a saccular aneurysm and dissection of the right vertebral artery at the fourth segment. In both cases, minor traumas were thought to be the causes of vertebral artery dissection. We surveyed previously reported 84 cases (men: 50, women: 34) of the vertebral artery dissection due to minor traumas. Seventy per cent of patients were in their third or fourth decade of life. The main causes of trauma preceding the dissection were neck manipulation especially chiropractics (52%). The third segment was most vulnerable. Delay in onset following neck trauma could be more than a week, but in most cases the delay was less than 24 hours. Cervical rotation and extension were thought to precipitate dissection.

Aortic Dissection↗

PubMed1996

Evaluation of extracranial vertebral artery dissection with duplex color-flow imaging.

BACKGROUND AND PURPOSE: We describe the diagnostic potential of duplex color-flow imaging in the evaluation of extracranial vertebral artery dissection. METHODS: Twenty patients with 24 extracranial vertebral artery dissections (four bilateral) were examined with duplex ultrasonography over a period of 6 years. Color-flow imaging was carried out in 16 of these patients. In 15 patients (75%), the dissection was temporally related to trauma. Angiography was available in 18 patients, confirming the diagnosis. RESULTS: In 15 patients, the diagnosis was primarily established with ultrasonography. Five patients with a dissection were referred for follow-up color-flow examinations. Six vertebral arteries were dissected at the origin or in the proximal V1 segment, one in the distal V2 segment, and one at the atlas loop. In contrast to other studies, the most frequent localization of the dissection in our patients was the region between the V1 and V2 segments (n = 16), where the most typical dissection site was the entrance of the artery into the transverse foramen of the C6 vertebra (n = 11). Typical ultrasonographic findings were irregular stenosis, dissecting membrane with true and false lumen, localized increase in diameter of the artery, pseudoaneurysm, intramural hematoma, and tapering stenosis with distal occlusion. In follow-up examination, a good regression of pathological findings was found in 17 dissections (70.8%). Two occlusions were completely recanalized. CONCLUSIONS: Extracranial vertebral artery dissections can be diagnosed noninvasively with duplex color-flow imaging. It is therefore a useful method for early diagnosis and follow-up examination.

Adolescent↗

PubMed1998

[Cerebellar infarction due to vertebral artery dissection in a girl].

We report here a case of vertebral artery dissection, which is rare in childhood. A 12-year-old, previous healthy girl was admitted to our hospital with symptoms of vertigo, tinnitus, hearing loss, nausea and vomiting. Although there was neither higher cortical dysfunction, motor weakness, sensory disturbance nor slurred speech. She could not stand up because of severe vertigo. Cranial magnetic resonance imaging (MRI) revealed a subacute cerebellar infarct. A left vertebral artery angiogram on the hospital day 3 demonstrated a sharp narrowing at the C1-C2 level. After an anticoagulant therapy for about 2 weeks, all the symptoms disappeared except for mild tinnitus. Two months later, a left vertebral artery angiogram showed an abrupt occlusion at the C1 level. MRI T1-weighted images demonstrated a thrombus within the false lumen of the dissected vessels. A flow void revealed the patency of the residual true lumen. From these findings, we made a diagnosis of vertebral artery dissection, which was considered to have caused cerebellar infarction. The patient was mostly normal at discharge, and 100 mg/day of aspirin has been given until present.

Aortic Dissection↗

PubMed2005

A case of vertebral artery dissection associated with morning blood pressure surge.

We report a case of a middle-aged man who suffered a cerebral infarction resulting from dissection of a vertebral artery associated with morning blood pressure surge. A 56-year-old man was transferred to our hospital with dizziness and vomiting in the early morning on a cold day in winter. He reported that he had been standing in front of the sink after bathing when he suddenly felt dizzy and fell down. He did not lose consciousness, and by the time he reached the hospital by ambulance, his dizziness had subsided, but he complained of severe headache and vomited 3 times. On admission, he was alert, and there were no neurological or radiological abnormalities (CT, MR angiography) in the brain. However, infarction in the left cerebellar hemisphere was detected by brain MRI on the 5th day of hospitalization. String sign of the left vertebral artery was noted by angiography, confirming the diagnosis of dissection of the left vertebral artery. Ambulatory blood pressure monitoring was performed after discharge. Although the mean 24-h blood pressure was in the normal range, a marked morning blood pressure rise was observed. We speculated that the acute rise of blood pressure in the early morning might have contributed to the dissection of the vertebral artery.

Atherosclerosis↗

PubMed1996

Bilateral vertebral artery dissection in a patient with afibrinogenemia.

BACKGROUND: Afibrinogenemia, a rare coagulation disorder, has not been associated with vertebral artery dissections. CASE DESCRIPTION: A 28-year-old woman with afibrinogenemia developed spontaneous neck pain followed by a right medullary infarction, and MR angiography showed extensive bilateral vertebral artery dissection. She was treated with fibrinogen replacement and anticoagulants and showed a favorable evolution, with only mild residual right upper arm incoordination. CONCLUSIONS: In this patient spontaneous bilateral vertebral artery dissection complicated afibrinogenemia. Since anticoagulant therapy is usually indicated for arterial dissection, this association created a therapeutic problem. This patient received anticoagulants with fibrinogen replacement, which resulted in a favorable evolution.

Adult↗

PubMed1992

Spontaneous vertebral artery dissection initially mimicking myocardial infarction.

BACKGROUND AND PURPOSE: Vertebral and carotid artery dissections may present with very different signs and symptoms, making early recognition difficult. However, diagnosis should be established as soon as possible to prevent unnecessary diagnostic investigations and to institute adequate treatment. CASE DESCRIPTION: A 46-year-old man presented with severe intermittent pain of his left upper arm and general discomfort. During extensive cardiological evaluation for suspected myocardial infarction, a severe brain stem syndrome occurred. Ultrasound Doppler studies detected vertebral artery dissection, which was confirmed by angiography. CONCLUSIONS: The unusual initial presentation of vertebral artery dissection delayed an early diagnosis and adequate treatment. Because noninvasive methods are available today, their applications are recommended in similarly uncharacteristic circumstances.

Aortic Dissection↗

PubMed2000

Extracranial vertebral artery dissection causing cervical root lesion.

The authors report an unusual manifestation of extracranial vertebral artery dissection (VAD), presenting with a predominantly motor radicular manifestation. Cervical magnetic resonance imaging (MRI) revealed the intramural hematoma in the dissected vessel wall, compressing mainly the segmental motor root and, to a lesser degree, the sensory ganglion. In the digital subtraction angiography (DSA), a circumscribed narrowing of the incriminated vessel was demonstrated. Color-coded Duplex imaging (CDDI) revealed complete recanalization after a few days of anticoagulation treatment. Complete neurologic recovery was seen after 3 months. Considering the MRI data, the likely pathogenetic mechanism was compression of the nerve root by the intramural hematoma. The synopsis with similar cases in the literature points to the characteristic features, i.e., the association of neck pain with radicular motor deficit and the absence of degenerative disk disease. The respective syndrome should raise the suspicion of vertebral artery dissection, especially in young individuals.

Adult↗

PubMedDate not supplied

Prevalence of vertebral artery dissection in Wallenberg syndrome: neuroradiological analysis of 93 patients in the Tohoku District, Japan.

To assess the prevalence of vertebral artery dissection in Wallenberg syndrome (lateral medullary syndrome), records of 93 patients (70 men, 21 women, and 2 patients not identified by gender; mean age at ictus, 58.1 years) with symptoms of Wallenberg syndrome who underwent MRI and/or vertebral angiography were reviewed retrospectively. Study items included the following: (A) headache; (B) arterial intramural hematoma on T1-weighted images as an MR finding; and (C) double lumen, intimal flap, pearl and string sign, and string sign as angiographic findings. These abnormal findings suggesting vertebral artery dissection were scored as 1 or 2 points. According to his or her total score, each patient was classified as "definite dissection." "probable dissection," "suspected dissection," or "no dissection." Twenty-three of 93 patients were classified as "definite dissection," 23 as "probable dissection," 27 as "suspected dissection," and 20 as "no dissection." The frequency of definite or probable dissection in Wallenberg syndrome was estimated at 50% or more. Thus, vertebral artery dissection is a frequent cause of Wallenberg syndrome.

Adult↗

PubMed2000

Vertebral artery dissection and migraine headaches in children.

Strokes of the posterior circulation are uncommon in childhood. In vertebrobasilar insults, vertebral artery dissection remains a rare diagnosis. We report the case of an 8-year-old boy with a history of migraine headaches who presented with acute cerebellar signs and agitation following multiple infarctions of bilateral cerebellar hemispheres. Vertebral angiography demonstrated dissection of the left vertebral artery with occlusion of the basilar artery just distal to its origin. Risk factors for vertebral artery dissection are reviewed, with emphasis on association with migraine headaches. A review of imaging studies for the diagnosis of dissection is also presented. This case demonstrates the importance of considering arterial wall dissection in pediatric patients with a history of atypical migraines associated with new neurologic findings.

Cerebral Angiography↗