Neurointervention.  2014 Sep;9(2):106-108. 10.5469/neuroint.2014.9.2.106.

Rapid Progression of Symptomatic Vertebrobasilar Artery Dissection on Magnetic Resonance Imaging: A Case Report

• Kim HS
• Kwak HS
• Hwang SB
• Chung GH

• KMID: 1910767
• DOI: http://doi.org/10.5469/neuroint.2014.9.2.106

Abstract

Spontaneous intracranial vertebrobasilar dissection can manifest with various clinical symptoms, including subarachnoid hemorrhage or ischemic symptoms from impaired posterior circulation. A 29-year-old woman came to our emergency department with a sudden onset of left sided mild motor weakness and headache. Initial magnetic resonance imaging (MRI) showed mild luminal irregularities in the vertebrobasilar arteries with an eccentric periluminal hematoma. Follow-up MRI obtained 3 days later showed a progression of vertebrobasilar dissection to multifocal stenoses with an increased intramural hematoma.

Keyword

Stroke; Vertebrobasilar dissection; Magnetic resonance imaging

MeSH Terms

Adult
Arteries*
Constriction, Pathologic
Emergency Service, Hospital
Female
Follow-Up Studies
Headache
Hematoma
Humans
Magnetic Resonance Imaging*
Phenobarbital
Stroke
Subarachnoid Hemorrhage
Phenobarbital

Figure

• 

  Fig. 1 A. The initial diffusion-weighted imaging showing an acute infarction in the right sided ventral pons. B. Time-of-flight magnetic resonance angiography showing the mild luminal irregularities in the vertebrobasilar arteries. C. A source image of time-of-flight magnetic resonance angiography showing the long-segment periluminal hematoma in the vertebrobasilar artery (arrow). D. Time-of-flight magnetic resonance angiography obtained 3 days later showing the multifocal stenoses (arrows) in the right vertebral and basilar artery. E. Axial, T1-weighted magnetic resonance imaging showing the eccentric intramural hematoma in the vertebrobasilar artery (arrow).

Reference

1. Hosoya T, Adachi M, Yamaguchi K, Haku T, Kayama T, Kato T. Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. Stroke. 1999; 30:1083–1090. PMID: 10229748.

2. Yamaura A, Ono J, Hirai S. Clinical picture of intracranial non-traumatic dissecting aneurysm. Neuropathology. 2000; 20:85–90. PMID: 10935444.

3. Tsukahara T, Minematsu K. Overview of spontaneous cervicocephalic arterial dissection in Japan. Acta Neurochir Suppl. 2010; 107:35–40. PMID: 19953368.

4. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001; 344:898–906. PMID: 11259724.

5. Arauz A, Marquez JM, Artigas C, Balderrama J, Orrego H. Recanalization of vertebral artery dissection. Stroke. 2010; 41:717–721. PMID: 20150549.

6. Kim BM, Kim SH, Kim DI, Shin YS, Suh SH, Kim DJ, et al. Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection. Neurology. 2011; 76:1735–1741. PMID: 21576691.

7. Yoshimoto Y, Wakai S. Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings. Stroke. 1997; 28:370–374. PMID: 9040692.

8. Ahn SS, Kim BM, Suh SH, Kim DJ, Kim DI, Shin YS, et al. Spontaneous symptomatic intracranial vertebrobasilar dissection: initial and follow-up imaging findings. Radiology. 2012; 264:196–202. PMID: 22550310.

9. Arnold M, Bousser MG, Fahrni G, Fischer U, Georqiadis D, Gandjour J, et al. Vertebral artery dissection: presenting findings and predictors of outcome. Stroke. 2006; 37:2499–2503. PMID: 16960096.