Vertebral Artery Dissection Presenting as Acute Cerebrovascular Accident

Kratz, Sabrina N.; Butler, Kenneth H.

doi:10.1016/j.jemermed.2007.11.039

Cited by 12 publications

(13 citation statements)

References 14 publications

(23 reference statements)

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“…2,9 Vertebral artery dissection is most common in younger patients or those with a history of trauma, whereas atherosclerosis is more likely in older patients with a history of hypertension, diabetes, smoking, and coronary artery disease. 2,10,11 Embolic stroke originating from the heart is another potential etiology that should be considered, particularly in patients with arrhythmias, cardiac dysfunction, or valvular disease. 12 …”

Section: Discussionmentioning

confidence: 99%

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Day

Swartz

Chenkin

et al. 2014

CJEM

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Patients with lateral medullary syndrome classically present with crossed hemisensory disturbance, ipsilateral Horner syndrome, and cerebellar signs, all of which are attributable to infarction of the lateral medulla. However, variability in the presentation of this syndrome is the rule, as illustrated in this case presentation and literature review. We propose an approach to diagnosis and management of the lateral medullary syndrome and illustrate the need to integrate clinical information with an understanding of brainstem anatomy with the goal of determining which patients require urgent neuroimaging and acute stroke therapies. The importance of recognition of this condition in the emergency department is underscored by the association between lateral medullary infarction and vertebral artery dissection. With optimal therapy, the prognosis for recovery from lateral medullary syndrome is good. RÉ SUMÉLes patients qui souffrent du syndrome bulbaire laté ral pré sentent gé né ralement des troubles hé misensoriels croisé s, un syndrome de Claude Bernard-Horner homolaté ral et des signes cé ré belleux, manifestations qui ré sultent toutes d'un infarctus du bulbe laté ral. Toutefois, le tableau clinique habituel du syndrome est variable, comme en té moignent un exposé de cas et l'examen de la documentation. Nous ferons donc é tat de l'approche diagnostique et de la prise en charge du syndrome bulbaire laté ral, et soulignerons la né cessité de rassembler tous les renseignements d'ordre clinique et de les mettre en relation avec l'anatomie du tronc cé ré bral afin de distinguer les patients devant subir d'urgence des examens en neuro-imagerie et des traitements pour un accident vasculaire cé ré bral. L'association entre l'infarctus du bulbe laté ral et la dissection de l'artè re verté brale fait ressortir l'importance de reconnaître cette premiè re affection au service des urgences. Moyennant le meilleur traitement possible, le syndrome bulbaire laté ral porte un pronostic favorable quant au ré tablissement.

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Section: Discussionmentioning

confidence: 99%

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Day

Swartz

Chenkin

et al. 2014

CJEM

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“…About 60% of VAD patients have symptoms of vertebrobasilar circulation ischemia, such as vertigo, hoarseness, dysphagia and cerebellar dysfunction [5]. Occipital headache and neck pain are common symptoms and occur in 70% of patients with VAD [6].…”

Section: Discussionmentioning

confidence: 99%

“…In the past, it was believed that mild or severe neck trauma caused mechanical stretching and compression of the vessel resulting in intimal disruption and intramural hemorrhage [5]. However, mechanical stress tends to affect extracranial segments, including V1 to V3, because of its mobility and prone to be damaged by bony structures [7].…”

Section: Discussionmentioning

confidence: 99%

Vertebral artery dissection associated with viral meningitis

Pan

Wang

et al. 2012

BMC Neurol

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BackgroundVertebral artery dissection (VAD) is often associated with trauma or occurs spontaneously, inevitably causing some neurological deficits. Even though acute infection can be related to the development of spontaneous VAD (sVAD), VAD associated with viral meningitis has never been reported in the literature.Case presentationA 42-year-old man with fever, sore throat, and runny nose developed sudden onset of occipital headache, vertigo, transient confusion, diplopia, and ataxia. Brain stem encephalitis was diagnosed initially because the cerebrospinal fluid (CSF) study showed inflammatory changes. However, subsequent diffusion-weighted (DWI) magnetic resonance imaging of his brain demonstrated left lateral medullary infarction, and the digital subtraction angiography (DSA) confirmed VAD involving left V4 segment of the artery. Consequently, the patient was diagnosed as VAD accompanied by viral meningitis.ConclusionThis case suggests that viral meningitis might lead to inflammatory injury of the vertebral arterial wall, even sVAD with multiple neurological symptoms.

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“…Vertebral artery dissection (VAD) is a relatively infrequent cause of transient ischemic attacks (TIA) and strokes. Overall, VAD is thought to be the cause of approximately 2% of all ischemic strokes, with increased frequency in younger patients, accounting for approximately 20% of strokes in patients less than 45 years of age [ 1 ]. VAD has been associated with extreme or abrupt neck flexion/extension, such as during a sneeze, coughing fit, cervical manipulation, or sexual intercourse.…”

Section: Introductionmentioning

confidence: 99%