Background and Purpose-We investigated the predictors and time course for recanalization after vertebral artery dissection. Methods-We prospectively studied 61 consecutive patients with confirmed diagnoses of vertebral artery dissection without intracerebral hemorrhage. Neuroimaging and clinical follow-up were performed at presentation and at 3, 6, and 12 months. Results-We included 61 patients with confirmed vertebral artery dissection; 19 were evaluated and followed up with conventional angiography, 24 with MR angiography, and 18 with CT angiography. Fifty-one patients had a stenotic dissection, 7 had an occlusive dissection, one had a double-lumen image, and 2 had a pseudoaneurysm. The estimated rate of complete recanalization after vertebral artery dissection was 45.9% at 3 months, 62.3% at 6 months, and 63.9% at 12 months. We found no association between outcome and complete or partial recanalization nor did we find any factors associated with recanalization. Conclusions-These results suggest that recanalization of vertebral artery dissection occurs mainly within the first 6 months after the onset of symptoms regardless of the location or pattern of the dissection. (Stroke. 2010;41:717-721.)

Background and Purpose: Earlier cases of stroke due to postpartum cerebral angiopathy have been reported. The mechanism of this angiopathy has not been explained.Case Description: We present a case of cerebral infarction with evidence of occlusive change in the vertebrobasilar system as a complication of intravenous ergonovine use after cesarean section delivery.Conclusions A few cases of stroke due to ergonovine use have been noted, including one case of intracerebral hemorrhage.6 " 9 We report a case of occlusive change in the vertebrobasilar arterial system secondary to the use of ergonovine after an uncomplicated cesarean section delivery, with arteriographic findings compatible with postpartum cerebral angiopathy.Case Report A 28-year-old woman was admitted for cesarean section delivery. She had no history of heart disease, migraine, arterial hypertension, or diabetes mellitus. There was no hypertension or proteinuria during pregnancy. Physical examination on admission revealed no abnormalities, and cesarean section was uncomplicated. Following delivery of the placenta, the patient received 0.2 mg i.v. ergonovine. After a few seconds, the patient developed sudden and severe headache with bilateral amaurosis and mild confusion. There was no elevation of blood pressure during the procedure.The neurological examination showed a confused patient with normal ocular fundi. Both pupils were 5 mm and reacted slowly to light. Extraocular movements were full. There was bilateral amaurosis. Motor function was normal. There was a right hemisensory deficit to all modalities. Vaiious blood studies (including those for hematologic antithrombin III, proteins C and S, immunologic rheumatoid factor, lupus erythematosus preparation, antinuclear antibodies, erythrosedimentation rate, and C3-C4 concentrations) were normal. Results of electrocardiography and bidimensional and contrast echocardiography were normal. Treatment with oral nimodipine and aspirin was started.

As endovascular techniques for treatment of direct CCFs continue to evolve, this novel approach with Onyx as the sole embolic material seems promising in treating these lesions.

✓ Vascular complications after percutaneous injection procedures for relief of trigeminal neuralgia are varied, ranging from puncture of arterial or venous structures to carotid-cavernous fistulas. The authors present a patient in whom an external carotid artery fistula occurred after a microcompression procedure for the treatment of a left-sided trigeminal neuralgia. This is believed to be the first case of this complication secondary to a percutaneous injection procedure for relief of facial pain.