Bilateral Vertebral Artery Dissection Research Articles

Cough-induced Bilateral Vertebral Artery Dissections in an Active Duty Service Member with Complete Angiographic Resolution (P8-5.005)

Cough-induced Bilateral Vertebral Artery Dissections in an Active Duty Service Member with Complete Angiographic Resolution (P8-5.005)

A case of bilateral vertebral artery dissection treated by bilateral surgical occlusion and low-flow bypass

Background: Bilateral vertebral artery dissection aneurysm (VADA) is a rare condition that leads to severe stroke. However, the surgical strategy for its treatment is controversial because the pathology is very complicated and varies in each case. Here, we report a case of bilateral VADA that was successfully treated with staged bilateral VADA occlusion and low-flow bypass. Case Description: A Japanese man in his 40s presented with bilateral VADA with subarachnoid hemorrhage. He had only mild headaches without any other neurological deficits. Subsequently, the ruptured left VADA was surgically trapped. However, on postoperative day 11, the contralateral VADA enlarged. The right VADA was then proximally clipped via a lateral suboccipital approach. Furthermore, a superficial temporal artery–superior cerebellar artery bypass was performed through a subtemporal approach in advance to preserve cerebral flow in the posterior circulation. The bilateral VADA was obliterated, and the patient had an uneventful postoperative course during the 1-year and 6-month follow-up period. Conclusion: Bilateral VADA can be successfully treated with staged bilateral VADA obstruction and low-flow bypass. In this case, as the posterior communicating arteries were the fetal type and the precommunicating segments of the posterior cerebral arteries (P1) were hypoplastic, a low-flow bypass was used to supply the basilar and cerebellar arteries, except the posterior cerebral and posterior inferior cerebellar arteries. Furthermore, low-flow bypass is a less invasive option than high-flow bypass.

Fatal Vertebral Artery Dissection Following Self-Manipulation of the Cervical Spine.

Cervical spine manipulation is a known risk factor for vertebral artery dissection. In this report, we present a case of fatal vertebral artery dissection that occurred as the result of self-manipulation of the cervical spine. The decedent was a 40-year-old man with no significant past medical history. He was observed to "crack his neck" while at work. Soon after, he began experiencing neck pain, then developed strokelike symptoms and became unresponsive. He was transported to a local medical center, where imaging showed bilateral vertebral artery dissection. His neurological status continued to decline, and brain death was pronounced several days later. An autopsy examination showed evidence of cerebellar and brainstem infarcts, herniation, and diffuse hypoxic-ischemic injury. A posterior neck dissection was performed to expose the vertebral arteries, which showed grossly visible hemorrhage and dilation. There was no evidence of traumatic injury to the bone or soft tissue of the head or neck. Bilateral dissection tracts were readily appreciated on microscopic examination. Death was attributed to self-manipulation of the neck, which in turn led to bilateral vertebral artery dissection, cerebellar and brainstem infarcts, herniation, hypoxic-ischemic injury, and ultimately brain death.

When headache is just too much—A case report and literature review of bilateral vertebral artery dissection

When headache is just too much—A case report and literature review of bilateral vertebral artery dissection

Clinical Characteristics, Course, and Outcomes of Vertebral Artery Dissections in the Postpartum Period; a Pooled Analysis of Published Case Reports.

Vertebral artery dissection (VAD) is a rare, but life-threatening condition. Compared to the general population, pregnant and postpartum women are more likely to develop VAD. Spontaneous arterial dissections have an ambiguous pathophysiology and may be difficult to manage. This study aimed to pool and analyze the data of published cases in this regard. We conducted a literature search on February 24, 2022, using MeSH terms of interest in PubMed, Google Scholar, Ovid, Web of Science, and Scopus databases to find studies on VAD following childbirth. A total of 28 studies were included in this review based on a database search. In the studies, 44 postpartum VAD (PPVAD) patients with a mean age of 34.26 ± 3.5 years were included. It took an average of 24.37± 13.7 days from delivery to dissection. 64% of the patients had developed unilateral dissection and 36% had developed bilateral dissection; 70% reported full recovery, and 9% did not achieve full recovery. The most common symptoms were headaches (89%), neck pain (64%), and hypertension (52%). The most common methods of diagnosis were magnetic resonance imaging (MRI) (64%) and computed tomography (CT) angiography (CTA) scan (66%). Only 8 (18%) cases reported the use of electrocardiography (ECG). The recorded outcomes of the patients with unilateral and bilateral postpartum VAD showed no statistical difference. Most of the included studies recommend early suspension and management for a better prognosis and prevention of complications. PPVAD is a severe medical condition but most cases were fully recovered after an early and proper antithrombotic plan for each case scenario.

Unilateral Upper Cervical Posterior Spinal Cord Infarction Caused by Spontaneous Bilateral Vertebral Artery Dissection.

A 41-year-old woman complained of sudden numbness of the left face and limbs without neck pain, paraparesis, urinary retention, or constipation. Neurologic examination revealed onion-skin pattern hemifacial dysesthesia and disturbance of touch and proprioception sensation of the left limbs. T2WI and Diffusion weighted imaging (DWI) showed left posterior spinal cord infarction at the C1 level (Figure, A–D). Magnetic resonance angiography (MRA) demonstrated stenosis of bilateral vertebral arteries (Figure, E–F). High-resolution MRI revealed the high signals of intramural hematoma in bilateral vertebral arteries indicating the diagnosis of dissection (Figure, G-J). Isolated posterior spinal cord infarction is rare, and vertebral artery dissection should be considered as an etiologic mechanism.1

Bilateral vertebral artery dissection after hair washing in a young woman

Bilateral vertebral artery dissection after hair washing in a young woman

A Case of Bilateral Vertebral Artery Dissection with Subarachnoid Hemorrhage Diagnosed by Vessel Wall Imaging

A Case of Bilateral Vertebral Artery Dissection with Subarachnoid Hemorrhage Diagnosed by Vessel Wall Imaging

Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke

Introduction : Traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45. Recent chiropractic neck manipulation is associated with risk of vertebral artery dissection (VAD). The V3 segment of the vertebral artery is highly susceptible to the bending forces during forced manipulation leading to intimal damage. Methods : N/A Results : This is a case presentation of a 44 year old male who was transferred from another emergency department for left homonymous inferior quadrantanopia noted on an optometrist visit. He reported sudden onset left homonymous hemianopia after receiving a high velocity cervical spine adjustment at a chiropractor appointment for chronic neck pain a few days prior. CT angiogram of the head and neck revealed bilateral vertebral artery dissection at left V2 and right V3 segments. MRI brain confirmed an acute infract in the right medial occipital lobe. His right PCA stroke was likely embolic from the injured right V3 but possibly from the left V2 as well. As the patient reported progression from a homonymous hemianopia to a quadrantanopia, he likely had a migrating embolus. Conclusions : Arterial dissection accounts for about 2% of all ischemic strokes, but may be between 8–25% in patients less than 45 years old. VAD can result from trauma of varying severities ‐ from sports, motor vehicle accidents, and chiropractor neck manipulations to violent coughing/sneezing. It is estimated that 1 in 20,000 spinal manipulation results in vertebral artery aneurysm/dissection. In the United States, patients who have multiple chronic conditions are reporting higher use of complementary or alternative medicine, including chiropractic manipulation. Education about the association of VAD and chiropractor maneuvers can be beneficial to the public as these are preventable acute ischemic strokes. In addition, vertebral artery dissection symptoms can be subtle and patients presenting to chiropractors may have distracting pain masking their deficits. Evaluating for appropriateness of cervical manipulation in high‐risk patients and detecting early clinical signs of VAD by chiropractors can be beneficial in preventing acute ischemic strokes in young patients.

Clinical Characteristics, Course, and Outcomes of Vertebral Artery Dissections in the Postpartum Period.

Postpartum vertebral artery dissections (ppVADs) are rare but potentially morbid conditions that occur in otherwise healthy patients. To evaluate clinical characteristics of ppVADs. Demographic, clinical, treatment, and outcome data were collected on ppVADs and are presented in a case series of 12 patients and compared to the general cohort. In total, 12 patients had ppVADs in our cohort of 310 patients with vertebral artery dissections (VADs). They occurred 11.27 days (95% CI, -0.85 to 23.39) postdelivery. Of these, there were 5 (42%) with a hypertensive disorder of pregnancy, and 4 (33%) who had migraines. A total of 3 (25%) had ischemic strokes and 1 (8%) had a subarachnoid hemorrhage. In total, 2 patients (17%) had unfavorable modified Rankin Scale (mRS, 2-6) at discharge from hospital. Patients with ppVADs more often had bilateral VADs (42%vs 17%, P=.03), had pseudoaneurysms (50%vs 18%, P=.0068), were younger (33.83 years vs 44.32 years, P=.018), and had lower Charlson Comorbidity Index (CCI = 0vs 0.99, P=.0038). Anticoagulant treatment was used in a similar percentage of patients. Multivariate analysis revealed 3 factors were predictive of change in mRS: CCI (OR=1.09, 95% CI, 1.02-1.15), stroke (OR=0.78, 95% CI, 0.65-0.95), and mRS at hospital discharge (OR=0.80, 95% CI, 0.74-0.87). There are only 15 isolated ppVADs reported in the literature; this study adds 12 patients with 17 ppVADs. Postpartum VADs occur in younger, healthier patients than in the general cohort, raising questions about mechanism of injury. The majority of ppVADs have good neurological outcomes.

Pregnancy as a Subgroup in the Pathophysiologic Classification of Spinal Aneurysms

Aneurysms of spinal arteries not associated with any known predisposing condition are referred to as isolated spinal aneurysms (SAs). In our series, an SA was found in 2 patients during the postpartum period. The goal of this study is to determine whether an occurrence of an SA may be related to puerperium. In a retrospective analysis of our consecutive series of 10 cases of SAs from 2008 to 2020, we identified 2 cases of SAs during puerperium. Patients' charts and imaging were reviewed, for potential predisposing factors. In both cases, angiography showed fusiform aneurysms of the anterior SA with concomitant bilateral vertebral artery (VA) dissections. Serum vasculitis andinflammatory panel and genetic testing for collagen disorders were negative in both cases. Review of the literature showed that pregnancy is associated with anincreased risk of arterial dissections in various locations and supports the hypothesis that hemodynamic andhormonal changes may play a role in the formation of SAs. Pregnancy and peripartum state may be a distinct cause of the formation of SAs, possibly as aresult of increased hemodynamic stress and hormonal changes that may alter the arterial wall. It would be appropriate to add pregnancy as a subgroup in the classification of SAs. In our series, both cases were associated with bilateral VA dissections; it is possible that the bilateral VA stenosis may have contributed to the formation of the SAs. It is important to recognize this possibility when considering the occlusion of a dissected VA.

P-MD009. A neurophysiological characteristic of holme’s tremor with thalamic lesion

Introduction. Holme’s tremor (HT) is defined as a slow frequency tremor with irregular amplitude that mostly occurs at rest and worsens with voluntary movements. Dystonia can be occurred with HT and almost all patients had thalamic lesions. The neurophysiological characteristics of HT are limited. The objective of this case report is to highlight the neurophysiological finding of HT with co-occurrence of dystonia from the thalamic lesion. Results. We reported a 46-year-old female patient with 13-year-history of left cerebellar infarction with bilateral vertebral artery dissection post left cerebellar hemispherectomy with full recovery. Recently she presented with left hemiparesis, hemiataxia and left hemianesthesia, diagnosed as the right thalamic hemorrhage. Seven months later, she developed irregular jerky movement of the left hand as well as dystonic posture. The neurophysiological test was done to distinguish among HT, myorhythmia and dystonic tremor. The one-axis accelerometer (ACC) was put on the left thumb and surface EMG was placed on the abductor pollicis brevis (APB), the flexor digitorum superficialis of the left index (FDS 2) and the left extensor indicis proprius (EIP). The ACC and EMG data showed regular sinusoidal movement of left hand at the peak frequency of 3 Hz with synchronous contractions of the antagonist pairs at rest. The similar pattern with larger amplitude of movement was demonstrated during postural holding at several positions. These findings were consistent with the definition of HT with concomitant dystonia rather than myorhythmia or dystonic tremor. The functional imaging also revealed hypometabolism of right thalamus, cerebral peduncle, medulla and left cerebellum. Botulinum toxin injection was done with good benefit. Conclusion. The neurophysiological test is capable to differentiate HT from mimics. Sinusoidal rhythmic slow oscillation with co-contraction of the antagonist pairs at rest with worsening at voluntary movements might indicate HT with concomitant dystonia.

Bilateral vertebral artery dissection after hair washing in a young woman

Bilateral vertebral artery dissection after hair washing in a young woman

Stenting of dominant artery due to symptomatic progression on bilateral vertebral artery dissection: A case report

Stenting of dominant artery due to symptomatic progression on bilateral vertebral artery dissection: A case report

Endovascular Treatment of Intracranial Vertebral Artery Dissection.

Intracranial vertebral artery dissection (VAD) is the most common arterial dissection in intracranial arteries. Some types of VAD can heal spontaneously after reconstitution of the vessel lumen with excellent prognosis, whereas others can progress to stroke that needs treatment. Recently, endovascular treatment (EVT) has emerged and is suggested as a treatment option for VADs due to perceived low rates of procedure-related morbidity with good efficacy. In the last decade, we have accumulated our strategies to treat those VADs. Here, we try to share our experiences about VADs, including indications and methods of treatment of VADs using EVT. We perform EVT for ruptured VADs presenting with SAH and some of unruptured VADs such as VAD with recurrent or progressive ischemia, dissecting aneurysm larger than 7 mm or with mass effect, early ugly change of VADs in shape and size during follow-up period, involving the basilar artery (BA) and bilateral VADs. We present how we have done in our real practice for the last decade for treating VADs by EVT rather than reviewing and organizing so-far-published literature. We tended to occlude the rupture point by vertebral artery (VA) occlusion in non-dominant VA or stent-assisted coiling in dominant VA for ruptured VADs. We tended to reconstruct original hemodynamics using various stents for unruptured VADs. To decide what to treat and how to treat are very complicated for VADs. However, we believe that EVT is the current mainstay for treating VADs. Each technique of EVT should be determined on a case-by-case basis at the discretion of endovascular neurosurgeons and/or interventional neuroradiologists according to presenting symptoms, hemodynamic status, including sufficiency of the collateral supply and anatomic features of the vertebrobasilar artery as well as the posterior inferior cerebellar artery, anterior spinal artery, and medullary perforators.

A case of bow hunter’s syndrome due to bilateral extracranial vertebral artery dissection in the craniovertebral junction caused by neck rotation

A case of bow hunter’s syndrome due to bilateral extracranial vertebral artery dissection in the craniovertebral junction caused by neck rotation

Bilateral vertebral artery dissection complicated by posterior circulation stroke in a young man

Introduction:Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. Improved imaging techniques can be used to detect VAD, whose current treatment options are limited.Patient concerns:The patient presented with neck and shoulder pain for a week after sleeping against the wall with cervical proneness for 1 night. He had sudden headache, slurred speech, and left side weakness for 1.5 hours on admission.Diagnosis:The patient had VAD complicated by posterior circulation stroke.Interventions:Acute stroke was treated with intravenous thrombolytic therapy. Then, the patient was administered follow-up anticoagulants.Outcomes:The patient's condition improved after thrombolytic therapy. He recovered well, with no recurrence during a 4-year follow-up.Conclusion:VAD should be taken into consideration in differential diagnosis of posterior circulation stroke or transient ischemic attack in young patients. Intravenous thrombolytic therapy may be safe and effective for stroke-complicated cases. This case report demonstrates that expanded diagnostic protocol for acute ischemic stroke assures rapid and correct diagnosis.

Bilateral Vertebral Artery Dissection Associated with an Electric Neck Massage Pillow

Bilateral Vertebral Artery Dissection Associated with an Electric Neck Massage Pillow

Bilateral vertebral artery dissections involving the left vertebral artery of aortic origin: A case report

Bilateral vertebral artery dissections involving the left vertebral artery of aortic origin: A case report

A case of bilateral vertebral artery dissection

A case of bilateral vertebral artery dissection