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]

• Swelling

  […] infection Oral contraceptive use References: [1] Clinical features Non- ischemic features Ipsilateral hea dache and facial/neck pain (constant, severe, throbbing or sharp) Partial horner syndrome : ptosis and miosis Pulse -synchronous tinnitus Neck swelling [amboss.com]

  Sub-intimal dissections swell and occlude the artery. The reduced blood flow rate and endothelial injury encourage thrombus formation, with the inevitable emboli causing brain stem and cerebellar infarctions. [academic.oup.com]

  An imaging study may predict deterioration from swelling. [stroke.ahajournals.org]

• Dyspnea

  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]

• Vomiting

  The patient presented to the emergency department with a 4-day history of vomiting and gait unsteadiness. A computed tomography scan of his head revealed multiple left cerebellar infarcts. [ncbi.nlm.nih.gov]

  He felt as though he might vomit, lurched from bed, and was noted to stumble to the left as he ran to the bathroom. He then vomited profusely. Upon return to bed he complained that the room was spinning; he continued to vomit intractably. [magmutual.com]

• Nausea

  Abstract A 33-year-old man presented with a lateral medullary infarction, vertigo, and nausea. At the time of hospital admission, he had Wallenberg syndrome. [ncbi.nlm.nih.gov]

• Hiccup

  These symptoms include ipsilateral facial numbness, contralateral body numbness, ataxia, nystagmus, vertigo, nausea / vomiting, dysarthria, dysphagia, hiccups, or ipsilateral Horner syndrome. [visualdx.com]

  Facial pain and numbness Loss of taste Tongue deviation Difficulty swallowing Slurred speech and/or hoarse voice Hearing loss (unilateral) Hiccups Double vision Movement of objects in the visual field with head movement (oscillopsia) Loss of sensation [healthhype.com]

  […] facial dysesthesia (pain and numbness)6: Most common 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 [emedicine.medscape.com]

• Hypertension

  Both patients also had a history of hypertension, which is frequently accompanied by ADPKD, and their serum creatinine levels were normal. [ncbi.nlm.nih.gov]

  Postpartum hypertension and nonsteroidal analgesia. Am J Obstet Gynecol. 2004;190(2):577–8. View Article PubMed Google Scholar Ghuman N, et al. Hypertension in the postpartum woman: clinical update for the hypertension specialist. [bmcpregnancychildbirth.biomedcentral.com]

  PMID 19321846. v t e Circulatory system pathology ( I, 390-459 ) Hypertension Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension ( Renovascular hypertension ) Ischaemic heart disease Angina pectoris ( Prinzmetal's angina ) [wikidoc.org]

• Thrombosis

  Thrombosis of a previously ruptured intracranial aneurysm is a frequent event and it most commonly occurs in large or giant aneurysms. [ncbi.nlm.nih.gov]

  / Phlebitis / Thrombophlebitis ( Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease ) - Varicose veins / Portacaval anastomosis ( Hemorrhoid, Esophageal [wikidoc.org]

• Blurred Vision

  A previously healthy 8-year-old boy presented to the emergency department with a 2-day history of headache and blurred vision that developed after going on a high-velocity amusement park ride. [ncbi.nlm.nih.gov]

  In 52 patients with VAD, Hicks et al. [ 7 ] found that 86% had ophthalmologic findings such as diplopia (45%), nystagmus (37%), ocular misalignment (33%), Horner's syndrome (27%), decreased corneal sensation (22%), ptosis (16%), blurred vision (14%) and [academic.oup.com]

  Signs and symptoms can range from vision loss to dysphagia. 2 We present the case of a patient who underwent a lumbar laminectomy at an outside hospital, and five days later presented to our institution with hoarseness. [practicalneurology.com]

• Prolapse

  Myocardial infarction (heart attack) - Dressler's syndrome Pulmonary circulation Pulmonary embolism - Cor pulmonale Pericardium Pericarditis - Pericardial effusion - Cardiac tamponade Endocardium / heart valves Endocarditis - mitral valve ( regurgitation, prolapse [wikidoc.org]

  DVT/PE, deep vein thrombosis/pulmonary embolus; GP, general practitioner; H/o, history of; HTN, hypertension; hyperH(e), Hyperhomocysteinemia; hyperlipid, hyperlipidemia; ICAD, internal carotid artery dissection; IL-6, interleukin-6; MVP, mitral valve prolapse [doi.org]

• Scotoma

  CASE REPORT: A 67-year-old came to our observation reporting burning pain in the right latero-cervical region in supine position, irradiated in the temporal region and recurrent episodes of migraine with aura (scintillating scotoma), in the last 3 months [ncbi.nlm.nih.gov]

  This was unlike her usual headaches where she develops occipital throbbing, scotoma, and photophobia but no nausea or phonophobia. She underwent cervical manipulation by her chiropractor which caused worsened neck pain and new headache. [slideshare.net]

• Suggestibility

  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]

• Distractibility

  VA dissection can occur as a result of different trauma types that cause excessive cervical rotation, distraction, or flexion-extension injuries. [evtoday.com]

• Headache

  In the present study, we attempt to identify the headache semiology that characterizes ICVAD and validate the revised version of the International Classification of Headache Disorders (ICHD-3 beta) criteria for headache attributed to intracranial artery [ncbi.nlm.nih.gov]

• Vertigo

  Vertigo was also associated with the stratification of Spontaneous Cervicocephalic Arterial Dissections Study criteria (P = 0·012). [ncbi.nlm.nih.gov]

• Dizziness

  A 39-year-old man suddenly felt sharp neck pain and dizziness when he swung a driver while playing golf and visited our clinic. Imaging studies showed acute right cerebellar infarction and complete occlusion of the right VA at the C2 (axis) level. [ncbi.nlm.nih.gov]

  The NRS status of the patient’s facial pain decreased from 8 to 1 in 1 day, and no complications such as dizziness, ataxia, or diplopia occurred during the follow-up period. [jneuro.com]

• Nystagmus

  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]

  These symptoms include ipsilateral facial numbness, contralateral body numbness, ataxia, nystagmus, vertigo, nausea / vomiting, dysarthria, dysphagia, hiccups, or ipsilateral Horner syndrome. [visualdx.com]

  HEENT: PERRL, EOM testing showed some rotatory nystagmus in all directions of gaze. Neck: supple without meningismus or audible bruits. Neurological exam: normal motor and sensory exam to light touch. Gait was ataxic to the left. [magmutual.com]

  You also observe that he has dysphagia and ptosis and miosis affecting his left eye, and loss of sweating on the left side of his face, consistent with Horner syndrome. 1 When he looks toward his left, you note horizontal nystagmus. [journals.lww.com]

• Intracranial Hemorrhage

  hemorrhage / cerebral hemorrhage : Extra-axial hemorrhage ( Epidural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage ) Intra-axial hematoma ( Intraventricular hemorrhages, Intraparenchymal hemorrhage ) - Anterior spinal artery syndrome - Binswanger's [wikidoc.org]

  Secondary outcomes include stroke occurrence or recurrence, any stroke during reported follow-up, extracranial hemorrhage, and intracranial hemorrhage. [doi.org]

  Intracranial dissections can complicate with subarachnoid hemorrhage and present a poorer outcome. 1,2 Early and accurate diagnosis of traumatic VA dissections, before stroke occurs, is essential to starting the most appropriate treatment. [evtoday.com]

This time a real workup was done. CT Angiogram shows “filling defect” inside the left middle cerebral artery — filling defect is something inside the artery that shouldn’t be there. [neuroangio.org]

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]

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]

We also present a review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this entity in sports. [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]

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 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]

Therefore, an active research attempt to optimize MR diagnosis and prognosis contribution in the most common stroke etiologies, such as atherosclerosis, or cervical artery dissection (CAD). [theses.fr]

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]

[…] vertebral artery ( ∼ 4:1 ) References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.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]

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. [scielo.br]

Author information 1 Department of Neuro-pathophysiological Imaging, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan. [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]

Pathophysiologically, two types of dissection are recognized. Steno-occlusive dissection results when arterial blood enters the potential space between the innermost (intimal) and middle (media) layers of the vessel wall. [docneuro.com]

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]

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]

In analogy to cardioembolic stroke (eg, atrial fibrillation), where anticoagulation is superior to antiplatelets (eg, aspirin) in secondary stroke prevention, 35 these observations would favor anticoagulation in stroke prevention of CAD. [doi.org]