Vertebrobasilar Occlusive Disease: Review of Selected Aspects

Abstract

Extracranial vertebral artery (VA) dissections usually present with unilateral occipital-nuchal pain or headache, often followed by lateral medullary or cerebellum ischemia. Posterior cerebral artery (PCA) ischemia may also occur. Women predominate, and the dissections are most often bilateral. The distal extracranial and proximal VA segments are most often affected. Recovery is common, and the lesions usually regress. Intracranial VA dissections are found more often in men. The dissections are usually unilateral and often extend into the basilar artery (BA). Subarachnoid hemorrhage (SAH) and brainstem ischemia are the commonest presentations. Ischemia is often severe, and fatal infarctions are common. Occasionally, patients present with mass effect. Some patients have chronic bilateral VA dissections that cause repeated ischemia or recurrent SAH. BA dissections are rarer but also show a male preponderance. Severe, often fatal, ischemia is the commonest presentation. SAH is rarer. The dissections often extend into the distal BA and cause rostral BA, superior cerebellar artery and PCA territory infarction.