Abstract
We report two different cases of stroke in young.First one is, a vertebral artery dissection following ferris wheel ride at amusement park which emphasise the clinical history in early diagnosis of stroke in young.The other one is, a recurrent stroke in marfan syndrome associated with basilar invagination and isolated atrial septal aneurysym which is rare and has unique way of management.
Highlights
Vertebral artery dissection is an important cause of posterior circulation ishaemia in young.Even without predisposing conditions for vertebral artery dissection there is a definite temporal correlation was present between neck movement, trivial trauma and acute arterial dissection[1]
Management consists intravenous heparin followed by oral oral anticoagualtion for all patients with acute dissections of the vertebral artery, regardless of the type of symptoms, unless there are contraindications such as the presence of a large infarct with associated mass effect, hemorrhagic transformation of the infarcted area, an intracranial aneurysm, and intracranial extension of the dissection with or without SAH[8].Endovascular therapy can be reserved for cases with recurrent neurological events despite on antithrombotics and who are all not a canditate for surgical therapy.Surgical therapy consists of insitu interposition of graft or extracranial intracranial bypass only for patients with persisting symptoms refractory to maximal non invasive management and who are not candidates for endovascular therapy.Continuation of anticoagulation therapy may be guided by MRA
75% of patients make excellent recovery and overall death rate is less than 5%.Risk of spontaneous dissection approximates 2% in the first month and decreases to about 1% per year.Dissection usually does not recur in the same vascular territory[10].By conclusion we emphasise the clinical history elicitation of neck movement related trivial trauma are most important even without predisposing conditions for vertebral artery dissection in stroke management
Summary
Vertebral artery dissection is an important cause of posterior circulation ishaemia in young.Even without predisposing conditions for vertebral artery dissection there is a definite temporal correlation was present between neck movement, trivial trauma and acute arterial dissection[1]. Case report 1: A 22year female, presented with sudden neck pain, vertigo and tendency to fall on left side ,three days following ferris wheel ride at amusement park. In view of neck pain, CT angiogram of neck and intracranial vessels were done which reveals V3 segment left vertebral artery dissection with significant stenosis(Figure2;Left vertebral arterial dissection with stenosis). The patient received intravenous heparin and aspirin for 5 days .She recovered completely without any neurological deficits.Patient discharged with oral anticoagulation afogatran 110 mg BD and aspirin 75 mg OD for 3 months. Follow up MR angiogram showed complete resolution of dissection with no flow limiting stenosis(Figure3:Normal neck and intracranial angiogram). Patient was aymptamatic and free from oral anticoagulants and aspirin
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