Bilateral Vertebral Artery Dissection Research Articles

Traumatic bilateral vertebral artery dissection

Traumatic vertebral artery dissection is not often seen by forensic pathologists, and cases investigated are scarce in the forensic literature. We present the case of a 40-year-old woman cyclist who was struck by a car while wearing a helmet, and was neurologically near normal immediately thereafter at Emergency. She presented 48 h later with acute right hemiparesis, decreasing level of consciousness, and unsteadiness. CT revealed massive cerebellar infarction. CT angiography was normal. The patient died in coma 7 days after injury and autopsy revealed bilateral edematous cerebellar infarction and bilateral vertebral artery dissection. Rotational neck injury and mural tear in the wall of the Atlantic parts of both vertebral arteries is suggested as the possible mechanism of the arterial injury. Head and neck injuries are reported as a precipitating cause of vertebral artery injury. The possible influence of trauma may be further underestimated if longer intervals between vessel dissection and ischemia occur. The current case illustrates that "talk-and-die" syndrome may be due to occult vertebral artery dissection, possibly bilateral. In forensic cases of delayed death after mild trauma to the head and neck, the vertebral arteries should be examined for the cause of death.

Unilateral and bilateral vertebral artery dissection following motor vehicle injury—Two cases and a mini-review

Vertebral artery dissection in two patients with traumatic brain and cervical spine injury was treated in the intensive care unit. In both cases vertebral artery dissection was suspected solely by the presence of ischemic lesions on the cervical spine and by magnetic resonance imaging of the brain, performed because of a failure to recover consciousness. In the intensive care unit patients with head and neck trauma, symptoms of posterior circulation ischemia due to traumatic vertebral artery dissection, often overlap with those with traumatic brain injury. A high level of suspicion for vertebral artery dissection has to be maintained in order to prompt further investigation in to these cases.

“Ostrich Sign” Indicates Bilateral Vertebral Artery Dissection

Vertebral artery dissections (VADs) comprise about 2% of ischemic strokes and can be associated with trauma, chiropractic manipulation, motor vehicle collisions, whiplash, amusement park rides, golfing, and other motion-induced injuries to the neck. We present a case of bilateral extracranial VAD as a complication of conducting an orchestra. To our knowledge, this has not been documented in the literature. Conceivably, vigorous neck twisting in an inexperienced, amateur conductor may place excessive rotational forces upon mobile portions of the verterbral arteries, tear the intima, deposit subintimal blood that extends longitudinally, and cause neck pain and/or posterior fossa ischemic symptoms. Magnetic resonance angiography examinations of axially oriented slices of bilateral VADs resemble the face of an ostrich. This observation is similar to the "puppy sign," in which bilateral internal carotid artery dissections resemble the face of a dog. Craniocervical dissections of either the carotid or vertebral arteries have the potential to form an aneurysm, cause artery-to-artery embolism, or completely occlude the parent artery, resulting in an ischemic stroke. Because bilateral VADs in axial magnetic resonance angiographic sections stand out like the eyes of an ostrich, and because the fast identification of VADs is so critical, we eponymize this image the "ostrich sign."

Bilateral internal carotid artery and vertebral artery dissections with retinal artery occlusion after a roller coaster ride - case report and a review

We present the first case of a woman with no significant medical history who developed dissections of bilateral carotid and bilateral vertebral arteries, as well as a retinal artery occlusion, after a roller coaster ride. A 35-year-old woman developed right-sided neck pain followed by a frontal headache immediately after a roller coaster ride. Five days after the incident, she developed complete loss of vision in her right eye for two hours. Subsequently, the vision improved but remained significantly decreased. On presentation, her visual acuity was 20/200 in the right and 20/20 in the left eye. Her fundus exam revealed retinal edema in the superotemporal retinal artery distribution without any visible emboli. Her neurological exam was otherwise normal. The cerebral angiogram showed bilateral internal carotid and vertebral artery dissections. The patient remained stable with conservative therapy without further worsening of vision or any new neurological deficits. Outcomes for cervicocephalic arterial dissection are usually favorable, but early diagnosis is critical for initiation of appropriate treatment of possible complications. Physicians must have a high index of suspicion for arterial dissection when patients note any headache, neck pain or vertigo triggered by violent motion after leisure activities such as roller coaster rides.

Basi-parallel Anatomical Scanning Magnetic Resonance Imaging in Patients With Bilateral Vertebrobasilar Artery Dissections -Case Report-

A 31-year-old man presented with bilateral unruptured vertebral artery (VA) dissections. The temporal course of the dissected arteries was successively evaluated using brain surface imaging modality basi-parallel anatomical scanning (BPAS) magnetic resonance (MR) imaging in combination with the conventional modalities of MR angiography and three-dimensional computed tomography (3D-CT) angiography. Initially, BPAS-MR imaging clearly demonstrated bilateral fusiform dilatations of the arterial wall, whereas MR angiography and 3D-CT angiography showed irregular, dilated, or interrupted inner contour of the arteries. Finally, BPAS-MR imaging demonstrated resolution of both aneurysms, and MR angiography demonstrated obstruction of the left VA and normal contours of the right VA. Combination of diagnostic tools such as BPAS-MR imaging and MR angiography is useful for evaluating the exact nature of dissected arteries and determining the temporal course.

Bilateral Vertebral Artery Dissection After Chiropractic Maneuver

There is an established epidemiologic association between chiropractic maneuvers and cervical artery dissection [1, 2]. In spite of clinical evidence, however, proof that spinal manipulative therapy can be the actual cause for dissection is still a matter of debate. It has been argued that chiropractic maneuvers are performed for neck pain that may have been caused by preexisting dissection of a cervical artery, and hence the manipulation may coincide with, rather than cause, the vessel lesion [3–5]. Here, we present the case of a young woman with posterior circulation strokes due to magnetic resonance imaging(MrI-)proven bilateral vertebral artery dissection. Clinical evidence strongly supports the notion that the dissection occurred during the maneuver, since an MrI scan prior to the manipulation showed a protruded intervertebral disk, and intact cervical vessels. Case Report

Bilateral internal carotid and vertebral artery dissection after a horse-riding injury

Blunt cerebrovascular injuries, defined as blunt injuries to the internal carotid or vertebral arteries, are uncommon and usually occur in victims of high-speed deceleration motor vehicle crashes. A blunt cerebrovascular injury after an equestrian accident is an extremely unusual presentation. In recent years, advances in screening and treatment with pharmacologic anticoagulation before the onset of neurologic symptoms have improved outcomes for these patients. Endovascular stenting and embolization, although unproven, offer a new potential approach for these complex injuries. We present a unique case of four-vessel blunt cerebrovascular injuries after a horse-riding injury that required multidisciplinary management.

Endovascular management of vertebral artery dissecting aneurysms: review of 25 patients.

Management of Vertebral Artery (VA) dissections remains controversial. The clinical and angiographic variables of VA dissections were evaluated to demonstrate the safety and efficacy of endovascular intervention in treatment of VA dissecting aneurysms. 25 patients with 27 VAdissecting aneurysms were treated with endovascular intervention during the last 10 years.17 patients were admitted with subarachnoid hemorrhage. 23 aneurysms treated using destructive endovascular trapping, while reconstructive techniques were used in 3 aneurysms treated with stent-assisted coiling and one aneurysm treated with false lumen embolization. The right VA was involved in 14 patients, the left VA in 9 patients, while 2 patients had bilateral VA dissection. The pearl and string sign was the commonest angiographic sign in 12 aneurysms. Perioperative complications included; rebleeding in one patient, symptomatic brain stem infarction in two patients and silent cerebellar ischemic lesion in one patient. Afavorable outcome was evident more in patients with unruptured VA dissection (100%) versus (76.5%) in patients presented with SAH. The endovascular technique should be individualized according to the clinical status of the patient, angiographic variables, condition of the posterior circulation and the available supplies.

Response to Facial Massage and Bilateral Carotid and Bilateral Vertebral Artery Dissection

Response to Facial Massage and Bilateral Carotid and Bilateral Vertebral Artery Dissection

Bilateral Carotid and Bilateral Vertebral Artery Dissection Following Facial Massage

A 50-year-old woman underwent facial massage. After 13 days, she experienced left retro-orbital pain, ptosis, and miosis. Magnetic resonance imaging (MRI) showed stenotic dissection of bilateral cervical internal carotid and vertebral arteries. The intracranial vasculature was intact. She was treated conservatively with long-term oral anticoagulation and remains asymptomatic 18 months later.

Bilateral vertebral artery dissection and infratentorial stroke complicated by stress-induced cardiomyopathy

A previously healthy 28-year-old Caucasian woman experienced a syncope and was referred to our emergency department. On admission, the patient was neurologically normal and alert. Electrocardiogram (ECG) was normal. Peripheral...

Bilateral Vertebral Artery Dissection Possibly Precipitated in Delayed Fashion as a Result of Roller Coaster Rides

A 34-year-old woman presented with a 5-month history of persistent vertigo after multiple roller coaster rides, followed by neck pain for 1 month and then 2 weeks of blurred vision related to diplopia. She was ultimately found to have bilateral cervical vertebral artery dissection. The images are described and the literature is reviewed regarding late diagnosis of vertebral dissection and prior cases of roller coaster-associated dissection.

Spontaneous bilateral carotid and vertebral artery dissections associated with multiple disparate intracranial aneurysms, subarachnoid hemorrhage and spontaneous resolution: Case report and literature review

Spontaneous bilateral carotid and vertebral artery dissections (CADs and VADs) are rare. A 29-year-old female presented with a collapse, 4 weeks after a sudden onset of severe neck and shoulder pain. CT scan revealed diffuse subarachnoid hemorrhage (SAH) and early hydrocephalus. Angiography revealed bilateral CADs and VADs, along with multiple fusiform and saccular aneurysms. Systemic vessels – including the renal arteries – were normal, and no risk factors or underlying vasculopathy were apparent. The presumed source of SAH (a posterior cerebral artery aneurysm) was successfully clipped. Each dissection, by contrast, was managed conservatively with heparin prophylaxis; and spontaneous CAD and VAD resolution occurred within 6 months. We present a unique case of four-vessel dissection associated with multiple disparate saccular and fusiform aneurysms. We suspect that underlying vasculopathy – perhaps novel – may become apparent with time.

Intracranial bilateral vertebral artery dissection during anticoagulation after cerebral venous and sinus thrombosis (CSVT)

A 37-year-old woman presented with cerebral venous and sinus thrombosis (CVST). During the period of anticoagulation she developed asymptomatic dissection of the intracranial segments of both vertebral arteries with an enlarging false aneurysm on the right side. Endovascular occlusion of the pathological segment of the right vertebral artery including the dissecting aneurysm and conservative management of the other side resulted in complete recovery without neurological complications.

Unusual visual symptoms in a patient with bilateral vertebral artery dissection: A case report

We present a previously unreported set of symptoms in a patient found to have bilateral vertebral dissections. Although visual symptoms are common in vertebral dissection, their pattern does not typically mimic those that commonly precede or accompany migraine headache. When they do occur, they usually take the form of diplopia or blurred vision. The patient we describe had visual symptoms that varied over three episodes of headache and included transient visual field loss and scintillations (“lightning bolts”), both common in migraine. However, our patient’s new visual symptoms represented a change in pattern from those that had accompanied her previous migraines. This detailed history-taking prompted an evaluation for an etiology other than migraine and prevented a further delay in diagnosis and treatment.

Traumatic bilateral vertebral artery dissection at the dural entry point site in a 10-year-old boy

We present a 10-year-old boy who was admitted with headache and neurological symptoms after a trauma in the school yard. Cerebral MRI revealed an extensive ischaemia in the bilateral cerebellar hemispheres, left middle cerebellar peduncle, and right vermis. Digital subtraction angiography demonstrated bilateral vertebral artery dissections at the dural entry point site. This case emphasises the management of patients with traumatic vertebral artery dissection.

Unilateral and bilateral vertebral artery dissection following motor vehicle injury—Two cases and a mini-review

Unilateral and bilateral vertebral artery dissection following motor vehicle injury—Two cases and a mini-review

Traumatic carotid cavernous fistula with bilateral carotid artery and vertebral artery dissections

Carotid and vertebral artery dissections from blunt cervical trauma are uncommon injuries that in recent years are becoming increasingly recognized as a result of angiographic screening protocols in trauma patients. Traumatic carotid cavernous fistulas are even less common events, but represent the most common intracranial vascular anomaly after head injury. The present report details the unique case of a woman with no history of collagen vascular disease who developed dissections of both carotid and both vertebral arteries, as well as a direct carotid cavernous fistula, after a motor vehicle collision. Her vascular injuries resolved without need for surgical or endovascular intervention.

Multiple cervical artery dissections

A 49-year-old man with a history of bilateral vertebral artery dissections (figure, A) presented with a left internal capsular infarct. A new left internal carotid artery dissection was found on angiography (figure, B, C). There were no findings of connective …

Dietary Supplements and Stroke

In the past, phenylpropanolamine (dl-norephedrine, an ephedrine alkaloid) was a common ingredient in appetite suppressants and cough and cold medicines. It has been associated with hypertension 1 and is an independent risk factor for hemorrhagic stroke in women. 2 Dietary supplements with ephedra alkaloids are also associated with cardiovascular and central nervous system adverse events. 3 A 36-year-old woman presented to the emergency department with headache, dizziness, nausea, vomiting, and abdominal discomfort. She was diagnosed with a migraine and was discharged with a prescription for promethazine. She later returned still complaining of headache and was referred to an outpatient clinic without emergency department evaluation. She was admitted from this clinic to the hospital for rehydration. On admission, noncontrast computed tomography of the head showed infarction of the posterior two thirds of the medial aspect of the right cerebellar hemisphere with adjacent localized mass effect. The next day, an acute stroke was confirmed on magnetic resonance imaging: fluid-attenuated inversion recovery axial images revealed increased signal in the right posterior inferior cerebellar artery (PICA) territory (A), and diffusion-weighted axial images showed increased signal consistent with restricted diffusion, which is indicative of acute ischemia (B). Cerebral angiography showed occlusion of the right PICA (C) and bilateral vertebral artery dissections (D). An extensive thrombophilia work-up revealed no evidence of a coagulation disorder. The patient had no risk factors for or family history of stroke. A urine drug screen confirmed the presence of ephedrine and phenylpropanolamine. After these findings were discussed, the patient’s husband brought in a bottle of the patient’s “diet and energy pills,” which listed ephedrine group alkaloids as one of the ingredients. Ephedrine alkaloid ingestion with resulting hypertension and subsequent vertebral artery dissection may be the mechanism of massive stroke in this otherwise healthy young woman. It is important to consider dietary supplement ingestion when evaluating young patients with unexpected stroke or myocardial infarction.