Outline of a Nationwide Study of Non-traumatic Intracranial Arterial Dissection in the Vertebrobasilar System: A Final Report

Abstract

A nationwide study (VAD 2013) was conducted over a year (January 1 to December 31, 2011) to elucidate the recent trends of the clinical features, radiographic findings, treatment, and outcomes of non-traumatic intracranial arterial dissection in the vertebrobasilar system. Here, we present the outline of the study. In this study, 632 patients from 172 neurosurgical institutes were enrolled. They were divided into 3 groups: (1) hemorrhage group consisting of 193 (30.5%) patients with subarachnoid hemorrhage; (2) ischemia group consisting of 209 (33.1%) patients with brain infarction or transient ischemic attack; and (3) headache group consisting of 230 (36.4%) patients. The following patient characteristics were recorded: age, sex, location of arterial dissection, initial radiographic findings, and serial changes in these findings, treatment, follow-up periods, and mid-term outcomes. The outcomes were evaluated using the modified Rankin scale (mRS), and a good outcome was defined as an mRS score of 0-2. Results: (1) Age and sex: The median age of the patients was 53, 52, and 50 in the hemorrhage, ischemia, and headache groups, respectively. Men outnumbered women in all the 3 groups; especially, in the ischemia group, the number of men was remarkably higher than that of women. (2) Location of arterial dissection: The vertebral artery was affected in 85% of the patients in both the hemorrhage and ischemia groups, and in 97% of the patients in the headache group. (3) Radiographic findings: Fusiform dilatation and pearl-and-string sign were the common findings in the hemorrhage group, whereas tapering string and occlusion were more frequent in the ischemia group. Regarding serial changes of the radiographic findings, improvement of the finding was the most common, followed by no change in both the ischemia and headache groups.(4) Treatment: Surgical treatment was administered to 82% of the patients, and endovascular surgery was the main procedure adopted for the hem

A Case of Intracranial Vertebral Artery Dissection Undetected by CT, MRI, and MRA at the Onset of Headache That Caused Subarachnoid Hemorrhage Seven Days Later

“…However, of these 3 patients who exhibited rupture, 2 underwent antithrombotic therapy before rupture. 2,3) In the above nationwide survey, 2) the initial imaging findings in patients with VAD presenting with headache at onset were fusiform dilatation in 41%, pearl and string sign in 29%, string in 14%, occlusion in 7%, multiple findings in 5%, and others in 4%, but there was no mention of patients with no initial findings, as in the present case.…”

A case of severe headache attributed to vertebral artery dissection

“…VAD can develop into a subarachnoid hemorrhage if the dissected section ruptures, and into cerebral infarction if vascular occlusion occurs in the dissected section, making it one of the most common causes of stroke in young people [5]. In Japan, a nationwide survey related to vertebrobasilar artery dissection found that bleeding and ischemia occur in as many as 30.5% and 33.1% of cases, respectively [6]. The vertebral artery branches into the posterior inferior cerebellar artery, anterior inferior cerebellar artery, superior cerebellar artery, and basilar artery, among others, which supply blood to the brainstem, cerebellum, cervical spinal cord, and other regions whose nourishment is directly linked to survival.…”

Investigation of the characteristics of headache due to unruptured intracranial vertebral artery dissection

“…Recently, the detection and diagnosis of unruptured IC-VAD has increased due to advancements in MRI (19,20). A Japanese nationwide study on IC-VAD reported that unruptured IC-VAD accounted for 69.5% of IC-VAD cases (14). In that study, among the unruptured IC-VAD, 47.6% of cases were of the ischemic type and 52.4% of cases were of the headache type.…”

“…In that study, among the unruptured IC-VAD, 47.6% of cases were of the ischemic type and 52.4% of cases were of the headache type. In ischemic type IC-VAD, 56.9% of the cases presented with headache (14). Thus, the majority of unruptured IC-VAD cases experience headaches.…”

“…It is well known that headache is the most common initial symptom in patients with IC-VAD (6,(9)(10)(11)(12)(13). IC-VAD is divided into three types based on the clinical symptoms: hemorrhagic type, ischemic type and headache type (14). In hemorrhagic type, or ruptured IC-VAD, the headache characteristics conform to those of subarachnoid hemorrhage.…”