Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Günther, Albrecht; Witte, Otto W.; Freesmeyer, Martin; Drescher, Robert

doi:10.1159/000452303

Cited by 12 publications

(9 citation statements)

References 34 publications

(45 reference statements)

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“…In this study, the typical arterial dissection, including a double lumen and an intimal flap, was observed in only 1 patient, whereas intramural hematoma dissections were more prevalent, similar to the reports in the literature. [ 7 – 9 ] Aneurysmal dissection, which relatively rarely occurs, if at all, [ 7 – 9 ] was also not found in this study.…”

Section: Discussioncontrasting

confidence: 52%

Extracranial vertebral artery dissection

Yang

Ran

2018

Medicine

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Vertebral artery dissection (VAD) is not uncommon in the young adult population. Owing to the various clinical manifestations; the diagnosis of VAD mainly depends on imaging examinations. Ultrasound has found an increasingly wide utilization in the diagnosis of VAD because of the continuous improvement in the resolution of ultrasonic instruments and accessibility.We retrospectively collected the data of patients with a US-proven extracranial vertebral artery dissection. In accordance with the sonographic findings, all patients were classified as having intramural hematoma, double-lumen dissection, and occlusion dissection. The patients’ age, sex, risk factors for cerebrovascular diseases, and sonographic characteristics were analyzed.A total of 37 cases of US-proven extracranial vertebral artery dissections were included in this study. Thirty patients presented with intramural hematoma dissection, 1 had double-lumen dissection and 6 had occlusion dissection. No dissecting aneurysm was found in any of the patients. Concerning a subsequent angiographic examination, 13 patients failed to undergo the examination for various reasons. The remaining 24 patients underwent digital subtraction angiography (DSA), magnetic resonance angiography (MRA), and computerized tomographic angiography (CTA), among whom 1 patient with intramural hematoma was underdiagnosed because the DSA result was interpreted as normal. One patient who underwent CTA had a contrast allergy. In the remaining patients, the results of other imaging examinations were consistent with the US results.Intramural hematoma dissection is the most common type of extracranial vertebral artery dissection. Over other angiographic examinations US has a big diagnostic advantage for its direct view, accuracy, and low cost.

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Section: Discussioncontrasting

confidence: 52%

Extracranial vertebral artery dissection

Yang

Ran

2018

Medicine

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“…3 18 19 Most patients with sVAD presented with vertebral artery stenosis or occlusion, which was also the most common angiography finding of sVAD in previous studies. [20][21][22][23] There might be different mechanisms of infarction between sVAD and carotid artery dissection (CAD). Artery-to-artery embolism is the major mechanism of CAD while vertebral perforator infarct and small scattered infarct constituted most of the sVAD.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological features of medullary infarction caused by spontaneous vertebral artery dissection

Zhu

et al. 2022

Stroke Vasc Neurol

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Background and purposeMedullary infarction (MI) caused by spontaneous vertebral artery dissection (sVAD) is an important type of stroke. It is important to distinguish sVAD from other causes of stroke since the treatment strategies and prognosis were different between them. In this study, we aimed to explore the clinical and radiological features of MI in patients with acute MI caused by sVAD.MethodsPatients with acute MI caused by sVAD and non-sVAD in a single tertiary hospital were enrolled from 2010 to 2020. Epidemiologic, clinical and image features were collected and analysed. MI lesions were categorised into three levels rostrocaudally and four arterial groups: anteromedial, anterolateral, lateral and posterior.ResultsA total of 128 patients with MI were enrolled with 47 cases of sVAD and 81 cases of non-sVAD. Patients with sVAD were younger than those with non-sVAD (med 44 years old vs 58 years old). The sVAD group was less likely to have hypertension (44.68% vs 67.90%; p=0.010) and diabetes (19.15% vs 45.69%; p=0.003), but more likely to have non-sudden onset (27.66% vs 9.87%, p=0.009), minor neck injury (19.15% vs 1.23%; p=0.001) and headache (46.81% vs 7.41%; p=0.000). Vertically, sVAD became more common in caudal medulla than in rostral medulla. Horizontally, the sVAD group was more likely to have lateral MI (91.48% vs 2.96%, p=0.000). In multivariable logistic regression analysis, age, non-sudden onset and headache were independently associated with sVAD with ORs of 0.935 (95% CI 0.892 to 0.981, p=0.006), 3.507 (95% CI 1.060 to 11.599, p=0.040) and 5.426 (95% CI 1.673 to 17.599, p=0.005).ConclusionsVAD was not uncommon in patients with MI, especially in patients with lateral MI. Young patients with headache and non-sudden onset should remind clinician the possibility of sVAD.

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“…Several imaging techniques are available for VAD diagnosis, including catheter-based DSA, contrast-enhanced computed tomography angiography, MRA, and ultrasound. [ 5 ] The most common angiographic findings are irregular stenosis, occlusion, pseudoaneurysm, irregular dilatation, intimal flap, line-like symptom, and double lumen. [ 13 ] DSA remains the gold standard for VAD diagnosis; however, MRA, computed tomography angiography, and DSA only clearly visualize the vessel lumen.…”

Section: Discussionmentioning

confidence: 99%

“…It is worth noting that MRI and ultrasound findings in patients with VAD vary considerably, indicating that the management algorithm should encompass a multimodality approach taking into consideration the patient history, clinical neurological examinations, and imaging techniques. [ 5 ]…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Wang

et al. 2020

Medicine

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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.

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Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Cited by 12 publications

References 34 publications

Extracranial vertebral artery dissection

Extracranial vertebral artery dissection

Clinical and radiological features of medullary infarction caused by spontaneous vertebral artery dissection

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

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