Abstract
BackgroundVertebral artery dissection (VAD) is often associated with trauma or occurs spontaneously, inevitably causing some neurological deficits. Even though acute infection can be related to the development of spontaneous VAD (sVAD), VAD associated with viral meningitis has never been reported in the literature.Case presentationA 42-year-old man with fever, sore throat, and runny nose developed sudden onset of occipital headache, vertigo, transient confusion, diplopia, and ataxia. Brain stem encephalitis was diagnosed initially because the cerebrospinal fluid (CSF) study showed inflammatory changes. However, subsequent diffusion-weighted (DWI) magnetic resonance imaging of his brain demonstrated left lateral medullary infarction, and the digital subtraction angiography (DSA) confirmed VAD involving left V4 segment of the artery. Consequently, the patient was diagnosed as VAD accompanied by viral meningitis.ConclusionThis case suggests that viral meningitis might lead to inflammatory injury of the vertebral arterial wall, even sVAD with multiple neurological symptoms.
Highlights
Vertebral artery dissection (VAD) is often associated with trauma or occurs spontaneously, inevitably causing some neurological deficits
This case suggests that viral meningitis might lead to inflammatory injury of the vertebral arterial wall, even spontaneous VAD (sVAD) with multiple neurological symptoms
It was reported that VADs might be associated with acute infection [3,4]
Summary
It is believed that vertebral artery dissection (VAD) is often associated with trauma and even less violent activities such as coughing or chiropractic manipulation [1,2]. We report here a case of sVAD associated with viral meningitis which was secondary to the upper respiratory tract infection. This patient manifested with variable symptoms including fever, headache, diplopia, vertigo, confusion,. The patient was healthy previously, and denied any head or neck trauma and chiropractic manipulation He smoked 10 to 15 cigarettes daily, without any use of alcohol or recreational drugs. Revealed that the pupils were equal and reactive to light, but horizontal nystagmus, hoarse voice and decreased movement of the left soft palate were noticed He had normal strength in all limbs but decreased pain sensation on the left face and right limbs. At one-month follow-up, the patient recovered completely, and repeated CSF study was normal
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