Bilateral spontaneous vertebral artery dissection complicated by bilateral posterior cerebral artery occlusion in a migraine patient: a case report with systematic review

Abstract

Migraines being a possible risk factor for spontaneous multivessel cervical artery dissection has been previously introduced but rarely discussed in literature. We present the case of a 32-year-old man with a history of migraines and a 2-week history of bilateral neck pain who was found to have bilateral Vertebral Artery dissection by CT angiography. The patient’s stroke’s etiology was spontaneous dissection followed by thromboembolism caused by bilateral Posterior Cerebral Artery (P1) occlusion. Due to an inability to protect his airway, he was scheduled to have a tracheostomy and percutaneous endoscopic gastrostomy (PEG). Over the following weeks, the patient continued to be unresponsive to stimuli, unable to follow commands, and unable to exhibit active/purposeful movement. As a result, the patient was transitioned to inpatient palliative care with total parenteral nutrition. We conducted a systematic literature review querying four databases: MEDLINE, Embase, CINAHL, and Academic Search Complete. Eligibility criteria were applied based on article type, title, abstract, and full text screening. Four case reports and three case-control studies discussing patients with a past medical history of migraines presenting with unilateral or bilateral vertebral artery dissection were identified and included in this review. We describe the possibility of the patient’s migraine history and potentially associated vasculopathy as a predisposing factor in the development of Vertebral Artery Dissection. Further research is needed to fully understand the exact mechanism occurring that predisposes migraine patients to spontaneous arterial wall injury.