Abstract
We present the case of a man in his thirties who had attended the emergency department with complaint of a distressing headache and associated intermittent facial droop with occasional slurred speech. The patient’s symptoms were bizarre in their nature as they were random, not sustained and he had long intervals when he was asymptomatic and was his normal self. During the course of admission his symptoms evolved resulting in neurological deficits which were more sustained, prompting the need for further imaging beyond the initial plain CT brain which showed no abnormality. This led to the diagnosis of vertebral artery dissection (VAD) complicated with an ischaemic stroke in the posterior inferior cerebellar artery distribution (PICA) on MRI/MRA. Dual anti-platelet treatment was commenced with the patient attaining gradual symptomatic improvement prior to discharge. He has reported some degree of neurological sequelae which he described as intermittent poor coordination on follow up visit in clinic after discharge.
Highlights
A 36-years old gentleman self-presented to the Spontaneous vertebral artery dissection has an estimated incidence of 1-1.5 per 100,000 classing it as a rare condition.[1]
Summary- We present the case of a man in his thirties who better diagnostic imaging modalities has been attributed had attended the emergency department with complaint of a as one of the factors rather than an actual rise in distressing headache and associated intermittent facial droop with occasional slurred speech
With absence of risk factors and atypical presentation, diagnosing vertebral artery dissection (VAD) and posterior circulation sustained, prompting the need for further imaging beyond the events in an acute sitting can be challenging as it initial plain CT brain which showed no abnormality
Summary
A 36-years old gentleman self-presented to the Spontaneous vertebral artery dissection has an estimated incidence of 1-1.5 per 100,000 classing it as a rare condition.[1]. Clinical examination in the emergency department did not yield any useful information as his symptoms were not reproducible besides his intermittent calling out in pain, this was not convincing for emergent imaging and on account of patient’s distress and poorly controlled symptoms he was referred to the medical team for review and further management. He was admitted under the neurology team and on assessment the following day symptoms had evolved and there was demonstrable neurological deficit. This was approximately 32 hours from initial presentation with earlier symptoms which in retrospect were caused by the dissecting vertebral artery and transient ischemic attacks involving the inferior cerebellar peduncle including parts of the area of supply of the right posterior inferior cerebellar artery (PICA)
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call