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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Vertebral artery dissection has a characteristic presentation that should be considered when symptoms are preceded by any trauma that causes neck movement. We present the case of a man with vertebral artery dissection following severe coughing that presented as a postero-inferior cerebellar artery territory stroke. The patient was anti-coagulated, and his neurologic deficits were partially resolved. The mechanism and presentation of vertebral artery dissection are discussed with an emphasis on early detection.
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PMID:Vertebral artery dissection from neck flexion during paroxysmal coughing. 153 97

Nine patients with dissections of the cervical arteries are presented. Dissections cause approximately three per cent of non-haemorrhagic stroke and are usually observed in young and middle-aged patients. Dissections very often give rise to head or neck pain. Carotid artery dissection may lead to lower cranial nerve dysfunction and an incomplete Horner's syndrome in case of subadventitial dissection, and to cerebral ischaemia in case of subintimal spread. Vertebral artery dissection may cause brain stem ischaemia (subintimal dissection) or in rare cases a subarachnoid haemorrhage (subadventitial spread). The history frequently reveals a (trivial) traumatic event. Diagnosis is usually established by angiography or MRI. The prognosis is good and recurrences are rare. Treatment with anticoagulants or acetylsalicylic acid seems recommendable, though scientifically unproven.
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PMID:[Dissection of cervical arteries as a cause of cerebral ischemia or cranial nerve dysfunction]. 221 57

Vertebral artery dissection seems to be a frequent cause of stroke in young adults. We report a 34 years old female that suffered a cardiac arrest while practicing aerobics, with complete recovery and four months later developed an acute Wallenberg's syndrome. Magnetic resonance imaging showed an infarction in the right posterolateral medulla oblongata and in the right cerebellar hemisphere. Angiography revealed an occlusion of the third segment (V3) of the right vertebral artery which was hypoplastic. The patient was anticoagulated with a favorable clinical outcome. A follow up angiography, performed six months later, showed an incomplete recanalization of the vessel. Vertebral artery dissection should be suspected in every patient with ischemic symptoms or signs related to the vertebrobasilar territory, specially in young or middle aged patients with a history of trauma. Magnetic resonance imaging and ultrasound-doppler examinations are the diagnostic test of choice.
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PMID:[Dissection of vertebral artery: report of a case and review of the literature]. 759 35

Vertebral artery dissection is an uncommon but important cause of posterior stroke in young and middle aged adults. We report a case with a long term fluctuating ischemic symptoms due to bilateral spontaneous dissection. Etiology and treatment are discussed.
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PMID:Vertebral artery dissection. Case report. 762 8

Using a standard protocol including MRI and magnetic resonance angiography (MRA), we studied 28 consecutive patients, all with an acute infarct in the lower brainstem. MRI patterns above and below the inferior olivary nucleus enabled identification of six topographical types of infarct: small midlateral, dorsolateral, inferolateral, large inferodorsolateral, dorsal and paramedian infarcts. Small midlateral, dorsolateral, inferolateral and inferodorsolateral infarcts were the most common types and were associated with Wallenberg's syndrome, with specific clusters and severity of neurological features in each of the four groups. Dorsal infarcts were both anatomically and clinically overshadowed by a constant associated cerebellar infarct in the posterior inferior cerebellar artery (PICA) territory. Paramedian infarction led to crossed tongue and sensorimotor hemiplegia, while a patient with an almost complete hemimedullary infarct had unusual ipsilateral sensory and motor disturbance due to lesion extension toward the upper spinal cord. A coexisting cerebellar infarct was present in 36% of the cases, but was never found with midlateral or inferolateral infarct. Angiography showed an embolic occlusion of the PICA in five patients (18%), four of them having dorsal or dorsolateral infarct. Atheromatosis was by far the most frequent stroke aetiology (72%), with intracranial vertebral artery tight stenosis or occlusion in 28% of the cases and in 75% of the cases with large inferodorsolateral infarct. Vertebral artery dissection and cardioembolism accounted each for 14% of the cases, the latter being associated with dorsal infarct. Our study shows that differences in topographical patterns of infarction in the lower brainstem probably reflect differences in aetiopathogenic mechanisms.
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PMID:Infarction of the lower brainstem. Clinical, aetiological and MRI-topographical correlations. 765 78

Vertebral artery dissection is an unusual condition with potentially protean neurologic presentations. It may occur spontaneously or follow apparently minor neck trauma. Ischemic symptoms related to the posterior circulation ensue and may be due to obstruction or embolization. The ensuing stroke is ischemic, although subarachnoid hemorrhage may be a complication as well. A case of vertebral artery dissection in a young woman who developed symptoms approximately one week after mild neck injury is reported, and the topic is reviewed.
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PMID:Dissection of the vertebral arteries: case report and discussion. 804 May 86

Vertebral artery dissection is an uncommon cause of stroke in children. Accuracy of diagnosis by magnetic resonance angiography (MRA) instead of invasive transfemoral angiography (TFA) has been controversial. The need for anticoagulation and duration of such therapy is also arguable. We report 2 boys with vertebral artery dissection: one, aged 7 years, presented with hemiparesis and seizures and the other, aged 4 years, presented with ataxia. Each boy's initial MRA was not interpreted as delineating occlusive lesions to explain the posterior circulation infarcts visualized on computed tomography and magnetic resonance imaging scans. However, subsequent MRAs were suspicious for vertebral artery dissection, which was confirmed by TFA. Both children were treated with anticoagulation therapy. The first patient continued to manifest evidence of new infarcts despite treatment (initially with aspirin alone, followed by anticoagulation with heparin and warfarin), and is now maintained on a combination of high dose warfarin and aspirin. The second patient is now maintained on aspirin alone after initial anticoagulation for 6 months with heparin followed by warfarin. A high index of suspicion for vertebral artery dissection may allow diagnosis on the basis of MRA alone. Previous reports have indicated good outcomes of vertebral artery dissection in children and adults irrespective of anticoagulation treatment. Our experience suggests that anticoagulation may be beneficial in preventing further strokes caused by the dissection.
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PMID:Vertebral artery dissection: issues in diagnosis and management. 873 12

Vertebral artery dissection (VAD) is an important cause of posterior circulation stroke in young adults. Initial symptoms are often non-specific and diagnostic arteriography is not performed until neurological deficits are obvious. Since magnetic resonance tomography (MRT) is superior in the diagnosis of vertebrobasilar ischemia, we retrospectively analyzed the role of MRT and MR angiography (MRA) in the detection of dissections of the vertebral artery. Between 1989 and 1995 we identified 24 patients with a vertebral artery dissection and 1 patient with a basilar artery dissection (8 females and 17 males, 23-60 years of age, mean 41.2 years). The diagnosis of VAD (14 left VAD, 9 right VAD, 1 bilateral VAD, 1 basilar artery dissection) was established by specific arteriographical findings (DSA) or clinical and neuroradiological course. All patients underwent a combined MRT/MRA examination protocol at 1.5T that consisted of spin-echo imaging and time of flight MRA of the intra- and extracranial arteries using 2D Flash and 3D Fisp sequences. The MRT/MRA findings were correlated to DSA and ultrasound results. During the acute and subacute stage, MRT/MRA revealed abnormal findings in 21 of 22 dissected vessels (95.5%). There was one false-negative MRT/MRA in a patient with a V1 dissection (intimal flap without peripheral flow disturbances). In 7/22 VAD the MRT/MRA findings were rated specific (double lumen n = 1, mural hematoma n = 4, pseudoaneurysm n = 2). DAS was sensitive in 100% and ultrasound in 77.3%. Specific results were obtained by DSA in 8/ 22 VAD (36.4%) and in 7/22 VAD (30.4%) by MRT/MRA. When MRT/MRA and DSA results were combined, the specific findings increased to 43.5%. Follow-up examinations revealed recanalization in 52% of initially stenosed or occluded vertebral arteries; four patients developed a pseudoaneurysm, and two of them underwent ligation of the VAD. With this retrospective approach, we were able to show a high sensitivity of MRT/ MRA for the presence of disturbed flow in the dissected vertebral artery. The MRA projections tended to overestimate stenosis and were inferior to DSA in the appreciation of irregularities of the vessel wall. Identification of high-grade stenosis, especially in the presence of distal occlusion, was improved on the MRA source images. During the acute and subacute stage, the diagnosis of luminal thrombus can be difficult, because signal ambiguities exist between hemoglobin breakdown products and flow effects and adjacent fat tissues. The differentiation between luminal thrombus and mural hematoma requires interpretation of MRA source images, together with flow compensated spin-echo images. Additional fat suppressed images and flow presaturation may be required at the appropriate levels. The identification of mural hematoma is important, because this finding is considered specific and cannot be obtained with DSA. There is a complementary role of MRT/MRA and DSA for an improved overall specificity for vertebral artery dissection. A negative MRT/MRA result in a patient with appropriate symptoms, however, cannot exclude a dissection and should prompt DSA. On the other hand, a suggestive MRT/MRA result in the appropriate clinical context can replace DSA. The advantage of MRT/MRA is that the method offers a simultaneous diagnosis of posterior fossa ischemia and vertebral artery abnormalities. Therefore, MRT/MRA should be recommended in patients with suspected VAD and especially in those who have no definite neurological deficit. These patients will benefit greatly from early diagnosis and therapy. The fact that all our patients were diagnosed after neurological symptoms and that 64% of them have residual deficits gives an ethical and economical rationale for advocating early MRT/MRA in these patients.
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PMID:[Magnetic resonance angiography and magnetic resonance tomography in dissection of the vertebral artery]. 903 29

Stroke in childhood is rare and has its own characteristic findings. Vertebrobasilar ischemia due to trauma in this age group has been described, but its specific features have not yet been clearly defined. Dissection of vertebral artery is one of the causes of vertebrobasilar ischemia that is very uncommonly detected in the intracranial portion of the posterior circulation in childhood. We report a 14-year-old boy with a history of neck trauma and transient vertigo attacks who presented with brainstem and cerebellar ischemic findings. Due to the large left cerebellar infarct size compressing the fourth ventricle, we performed emergent posterior fossa decompression. Digital cerebral subtraction angiography revealed left vertebral artery dissection beginning at the V1 portion to the level of V4 and distal thrombosis of basilar artery. After 2 months, he was discharged from the hospital with minor neurologic deficit with anticoagulation therapy. Due to better outcome in childhood, early investigation for intracranial dissection should be included in the evaluation of posterior circulation infarcts in this age group.
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PMID:Case of intracranial vertebral artery dissection in young age. 904 7

Vertebral artery dissection is an extremely rare but serious precursor to stroke. A case study illustrates how accurate early assessment and diagnosis can permit prompt intervention. Favorable treatment outcomes can occur when such astute management takes place.
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PMID:Stroke following vertebral artery dissection: a case study. 978 91


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