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Vertebral Artery Dissection


Presentation

  • We successfully treated a patient for persistent vessel injury presenting with SAH 7 years after presenting with extracranial subocclusive dissection of the right vertebral artery and an associated right posterior inferior cerebellar artery stroke.[ncbi.nlm.nih.gov]
  • First patient, presented with sudden onset of headache, left hypoacusia and right hemiparesis, posteriorly developing gaze-evoked nystagmus and worsening right-sided weakness.[ncbi.nlm.nih.gov]
  • Moreover, the heterogeneous presentation and manifestations of such cases require individualized treatment, and warrant studies into underlying mechanisms behind extracranial dissection and nonaneurysmal SAH.[ncbi.nlm.nih.gov]
  • We also present a review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this entity in sports.[ncbi.nlm.nih.gov]
Hunting
  • Unfavorable Hunt-Hess grade and older age were independent predictors of unfavorable outcomes in ris-VADAs.[ncbi.nlm.nih.gov]
  • The effect of pregnancy and parity on headache prevalence: the Head-HUNT study. Headache. 2009;49(6):851–9. View Article PubMed Google Scholar Ramchandren S, Cross BJ, Liebeskind DS.[bmcpregnancychildbirth.biomedcentral.com]
  • Link Google Scholar 641 Kelly J, Rudd A, Lewis R, Hunt BJ. Venous thromboembolism after acute stroke. Stroke. 2001 ; 32 : 262–267. Crossref Medline Google Scholar 642 Sun KK, Wang C, Guli XT, Luo Q.[stroke.ahajournals.org]
  • Link Google Scholar 641 Kelly J, Rudd A, Lewis R, Hunt BJ. Venous thromboembolism after acute stroke. Stroke . 2001 ; 32 : 262–267. Crossref Medline Google Scholar 642 Sun KK, Wang C, Guli XT, Luo Q.[doi.org]
HELLP Syndrome
  • Spontaneous cervical artery dissection has been rarely reported in the postpartum period but never in association with HELLP syndrome.[ncbi.nlm.nih.gov]
  • Bilateral thalamic infarct caused by spontaneous vertebral artery dissection in pre-eclampsia with HELLP syndrome: a previously unreported association. J Stroke Cerebrovasc Dis. 2012;21(8):914. e9-10.[bmcpregnancychildbirth.biomedcentral.com]
Sore Throat
  • A 42-year-old man with fever, sore throat, and runny nose developed sudden onset of occipital headache, vertigo, transient confusion, diplopia, and ataxia.[ncbi.nlm.nih.gov]
Colic
  • Eight days after admission, the patient experienced sudden hypovolemic shock because of an abdominal hemorrhage, which was diagnosed as the rupture of an aneurysm in the accessory middle colic artery and treated with urgent coil embolization.[ncbi.nlm.nih.gov]
Osteophyte
  • This syndrome is has various causes, such as osteophytes, tumors, fibrous bands, infection, and trauma. We report a unique case of bow hunter's syndrome. The patient visited our hospital because of left nuchal pain.[ncbi.nlm.nih.gov]
  • Most cases reported in the literature have been attributed to osteophytic compression, either from the occipital condyle or within the transverse foramen.[ncbi.nlm.nih.gov]
Truncal Ataxia
  • Her headache, vertigo, and truncal ataxia were completely improved one week later.[ncbi.nlm.nih.gov]
  • ataxia Nystagmus [3] Ipsilateral Horner syndrome [4, 5] Ipsilateral hypogeusia or ageusia (ie, diminished or absent sense of taste) Ipsilateral impairment of fine touch and proprioception Contralateral impairment of pain and thermal sensation in the[emedicine.com]
Quadriplegia
  • Gradually, although the patient remained conscious, he could not speak but could communicate with the surrounding by blinking or moving his eyes, and turned to complete quadriplegia, complete facial and bulbar palsy, dyspnea at 4 hours after admission[ncbi.nlm.nih.gov]
  • Alive - no neurological deficit Case 4 30 Previous IUGR and post partum eclampsia Yes - NSAID induced postpartum HTN Left sided neck pain No Postnatal Aspirin Alive - no neurological deficit McKinney J et al. [ 1 ] 41 None Yes Headache, HTN, Dysarthria Quadriplegia[bmcpregnancychildbirth.biomedcentral.com]
Decerebrate Posturing
  • Ten hours later, patient declined (hypertensive and unresponsive) and was noted to have decerebrate posturing. After emergent intubation, he was transferred to the pediatric intensive care unit.[ncbi.nlm.nih.gov]
Alteration of Consciousness
  • Clinical symptoms included nausea, vomiting, and rapid alteration of consciousness. Magnetic resonance imaging showed total occlusion of the basilar artery, and angiography confirmed VAD from the third to the fourth segments.[ncbi.nlm.nih.gov]
Oscillopsia
  • […] symptom Dysarthria or hoarseness (cranial nerves [CN] IX and X) Contralateral loss of pain and temperature sensation in the trunk and limbs Ipsilateral loss of taste (nucleus and tractus solitarius) Hiccups Vertigo [1] Nausea and vomiting Diplopia or oscillopsia[emedicine.com]

Workup

  • See Workup for more detail.[emedicine.com]
  • Imaging the Cerebral Vasculature An important aspect of the workup of patients with stroke, transient ischemic attack (TIA), or suspected cerebrovascular disease is the imaging of the extracranial and intracranial vasculature.[stroke.ahajournals.org]

Treatment

  • Ischemic and hemorrhagic events occurred in 8.5% on antiplatelet treatment, 15.4% on anticoagulation, and 18.2% on combined treatment.[ncbi.nlm.nih.gov]
  • BACKGROUND: Endovascular internal trapping is an effective procedure for the treatment of acute vertebral artery dissection (VAD). However, the outcomes of reconstructive treatment have not been well established.[ncbi.nlm.nih.gov]
  • This is the first report of hemorrhagic bilateral VAD treated with bilateral trapping and aggressive spasm treatment in the acute phase. However, the treatment was not successful.[ncbi.nlm.nih.gov]
  • Different endovascular treatment modalities are comparatively safe and effective in the management of vertebral artery dissection.[ncbi.nlm.nih.gov]
  • Combined thrombolytic therapy may provide safe and effective treatment of stroke-complicated cases.[ncbi.nlm.nih.gov]

Prognosis

  • We also present a review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this entity in sports.[ncbi.nlm.nih.gov]
  • Likewise, it is important to obtain the input of neurologists to optimize a patient's prognosis and minimize long-term sequelae.[ncbi.nlm.nih.gov]
  • Poor prognosis was associated with (1) bilateral dissection; (2) intracranial VA dissection accompanied by subarachnoid hemorrhage. Only two patients reported stroke recurrence.[ncbi.nlm.nih.gov]
  • Prognosis of Patients with spontaneous Vertebral Artery dissection is good & 90% are expected to make an excellent recovery. Those associated with SAH have guarded prognosis.[vertebralarterydissection.com]
  • We also discuss a brief review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this rare entity.[ncbi.nlm.nih.gov]

Etiology

  • More recently, nonischemic lesions in brain and brain stem have also been described as etiologies of MBS. There are few reports describing spinal cord infarction leading to MBS.[ncbi.nlm.nih.gov]
  • Vertebral artery dissection (VAD) is an important and under-recognized etiology of stroke in young patients. No clinical symptoms or signs appear to be specific for VAD.[ncbi.nlm.nih.gov]
  • Etiology Frequently caused by penetrating or blunt trauma (e.g., high impact car accidents) but up to 40% of cases result from mild trauma (e.g., minor sports injuries ) or other mechanical triggering events (e.g., coughing , sneezing, chiropractic maneuvers[amboss.com]
  • However, cervical dissections are the underlying etiology in as many as 20% of the ischemic strokes presenting in younger patients aged 30-45 years.[emedicine.com]
  • Etiology blunt trauma (most common) antecedent neck manipulation or other sudden movements 5,10 spontaneous fibromuscular dysplasia (FMD) connective tissue diseases 2 Ehlers-Danlos disease Marfan's disease pseudoxanthoma elasticum Dissections are mostly[radiopaedia.org]

Epidemiology

  • BACKGROUND: The natural history and epidemiological aspects of traumatic vertebral artery dissection (VAD) are not fully understood. We determined the prevalence of VAD and impact on outcome of patients with head and neck trauma.[ncbi.nlm.nih.gov]
  • […] artery ( 4:1 ) References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • Cervical artery dissection: pathology, epidemiology and management. Thromb Res. 2009 Apr. 123(6):810-21. [Medline]. Raupp SF, Jellema K, Sluzewski M, de Kort PL, Visser LH. Sudden unilateral deafness due to a right vertebral artery dissection.[emedicine.com]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • EPIDEMIOLOGY SCAD accounts for about 25% of strokes in patients under 45 years old 10,11. The annual incidence is estimated to be 2.6 to 5 per 100000 12,13.[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • Author information 1 Department of Neuro-pathophysiological Imaging, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.[ncbi.nlm.nih.gov]
  • Our discussion covers the proposed pathophysiology of vertebral artery dissection in HDP and the management of it.[ncbi.nlm.nih.gov]
  • The underlying mechanism is likely different in each group, and treatment strategies should also be tailored depending on the pathophysiology.[ncbi.nlm.nih.gov]
  • Differences in risk factor profile and structural features between carotid and vertebral dissection suggest that their pathophysiology may partly differ.[doi.org]
  • Recent studies provide insights into the pathophysiology, risk factors, management, and outcome of this condition. In this article, the author provides a comprehensive review of spontaneous (nontraumatic) carotid and vertebral artery dissections.[medlink.com]

Prevention

  • He underwent superficial temporal artery (STA)-superior cerebellar artery (SCA) bypass for the prevention of fatal brain stem infarction. He had consciousness disturbance 2 days postoperatively.[ncbi.nlm.nih.gov]
  • This case also suggests that careful history taking and awareness of the symptoms of VAD are necessary to diagnose this entity as timely diagnosis and treatment can prevent permanent disability or even death.[ncbi.nlm.nih.gov]
  • The identification of this disease is paramount for adequate clinical intervention and brain ischemia prevention.[scielo.br]
  • To prevent aspiration, keep him N.P.O., including all oral medications until a swallowing evaluation is completed. Place him on a cardiac monitor, establish vascular access, and start an I.V. infusion as prescribed.[journals.lww.com]

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