VERTEBRAL ARTERY DISSECTION: CASE REPORT
Keywords:
vertebral artery dissection, cerebrovascular accidentAbstract
Case report: A 36-year-old female patient with no cardiovascular risk factors was admitted as an emergency due to a disturbance in the gait and balance, dizziness, headache, which started suddenly approximately one day before admission to the neurology department. Nuclear magnetic resonance imaging studies showed an ischemic event in the left segment of the medulla oblongata, associated with a history of neck injury. NMR of the brain with FS sequence found a dissection of the left vertebral artery in proximal intracranial segment, approximately 1 cm in length. After conservative treatment with antiplatelet and antilipemic therapy, neurological improvement was observed. After one and a half years of follow-up, there was no recurrence of the same or similar neurological symptomatology. Conclusion: This paper highlights the importance of neck trauma, even after some time latency following the initial injury, as a cause of vertebral artery dissection and subsequent ischemic brain damage. This enables timely diagnostic and therapeutic actions, which certainly contribute to a better final outcome, which is a basic goal in our daily work.
References
Hart RG. Vertebral artery dissection. Neurology 1998; 38(6): 987-989. doi: 10.1212/wnl.38.6.987.
Trager RJ, Troutner AM, Pikus HJ, Daniels CJ, Dusek JA. Symptoms of patients with vertebral artery dissection presenting to chiropractors: a systematic review and meta-analysis. Cureus 2023; 15(12): e51297. doi: 10.7759/cureus.51297.
Lee VH, Brown RD, Mandrekar JN, Mokri B. Incidence and outcome of cervical artery dissection: a population-based study. Neurology 2006; 67(10): 1809-1812. doi: 10.1212/01.wnl.0000244486.30455.71.
Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, et al. Vertebral artery dissection: presenting findings and predictors of outcome. Stroke. 2006; 37(10): 2499-2503. doi: 10.1161/01.STR.0000240493.88473.39.
Bond KM, Krings T, Lanzino G, Brinjikji W. Intracranial dissections: A pictorial review of pathophysiology, imaging features, and natural history. J Neuroradiol 2021; 48(3): 176-188. doi: 10.1016/j.neurad.2020.03.007.
Hart RG, Easton JD. Dissections of cervical and cerebral arteries. Neurol Clin. 1983;1(1):155-82.
Talarowska P, Dobrowolski P, Klisiewicz A, Kostera-Pruszczyk A, Członkowska A, Kurkowska-Jastrzębska I, et al. High incidence and clinical characteristics of fibromuscular dysplasia in patients with spontaneous cervical artery dissection: The ARCADIA-POL study. Vascular Medicine 2019; 24(2): 112-119. doi: 10.1177/1358863X18811596.
Schievink WI. The treatment of spontaneous carotid and vertebral artery dissections. Curr Opin Cardiol 2000; 15(5): 316-321. doi: 10.1097/00001573-200009000-00002.
Price R, Sellar R, Leung C, O'sullivan M. Vertebral arterial dissection and vertebrobasilar arterial thrombosis successfully treated with endovascular thrombolysis and stenting. AJNR Am J Neuroradiol 1998; 19(9): 1677-1680. PMID: 9802490.
Harshavardhana NS, Dabke HV. Risk factors for vertebral artery injuries in cervical spine trauma. Orthop Rev (Pavia) 2014; 6(3): 5429. doi: 10.4081/or.2014.5429.
Park KW, Park JS, Hwang SC, Im SB, Shin WH, Kim BT. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. J Korean Neurosurg Soc 2008; 44(3): 109-115. doi: 10.3340/jkns.2008.44.3.109.
Desouza RM, Crocker MJ, Haliasos N, Rennie A, Saxena A. Blunt traumatic vertebral artery injury: a clinical reviewEur. Spine J 2011; 20(9): 1405-1416. doi: 10.1007/s00586-011-1862-y.
Schellinger PD, Schwab S, Krieger D, Fiebach JB, Steiner T, Hund EF, et al. Masking of vertebral artery dissection by severe trauma to the cervical spine. Spine 2001; 26(3): 314-319. doi: 10.1097/00007632-200102010-00019.
Markus HS, Levi C, King A, Madigan J, Norris J, Antiplatelet Therapy vs Anticoagulation Therapy in Cervical Artery Dissection: The Cervical Artery Dissection in Stroke Study (CADISS). Randomized Clinical Trial Final Results. JAMA Neurology 2019; 76(6): 657-664. doi: 10.1001/jamaneurol.2019.0072.
Kleindorfer DO, Towfighi A, Chaturvedi S, Cockroft KM, Gutierrez J, Lombardi-Hill D, et al. Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack: A Guideline from the American Heart Association/American Stroke Association. Stroke 2021; 52(7): e364-e467. doi: 10.1161/STR.0000000000000375.
Debette S, Mazighi M, Bijlenga P, Pezzini A, Koga M, Bersano A, et al. ESO guideline for the management of extracranial and intracranial artery dissection. Eur Stroke J 2021; 6(3): XXXIX-LXXXVIII. doi: 10.1177/23969873211046475.
