Korean J Neurotrauma.  2013 Oct;9(2):69-73. 10.13004/kjnt.2013.9.2.69.

Clinical Experiences of Unruptured Vertebral Artery Dissection

• Kim JS
• Cheong JH
• Lee SK
• Kim JM
• Kim CH

• KMID: 2156103
• DOI: http://doi.org/10.13004/kjnt.2013.9.2.69

Abstract

OBJECTIVE
The natural course of unruptured vertebral artery dissection remains unclear. The clinical manifestation of unruptured vertebral artery dissection varies from headache, focal neurologic deficits caused by ischemia to subarachnoid hemorrhage with high mortality. The purpose of this study is to investigate the clinical course of unruptured vertebral artery dissection.
METHODS
From March 2011 to April 2013, 7 patients with headache or nuchal pain by spontaneous vertebral artery dissection visited our institute were retrospectively reviewed. Their clinical data was obtained by medical records and radiologic studies including computed tomographic angiography, magnetic resonance imaging, magnetic resonance angiography and digital subtraction angiography.
RESULTS
No patient experienced fatal outcome by subarachnoid hemorrhage or vertebrobasilar ischemia during follow-up period. Radiologic studies also did not show the evidence of subarachnoid hemorrhage or vertebrobasilar ischemia. Follow-up angiography showed the decreased size or disappearance of aneurysm in 3 patients.
CONCLUSION
This study suggests that the natural course of unruptured vertebral artery dissection is not aggressive. Patients with unruptured vertebral artery dissection could be managed with conservative treatment including anticoagulants and/or antiplatelet agents.

Keyword

Vertebral artery dissection; Subarachnoid hemorrhage; Dissecting aneurysm

MeSH Terms

Aneurysm
Aneurysm, Dissecting
Angiography
Anticoagulants
Fatal Outcome
Follow-Up Studies
Headache
Humans
Ischemia
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Medical Records
Mortality
Neurologic Manifestations
Platelet Aggregation Inhibitors
Retrospective Studies
Subarachnoid Hemorrhage
Vertebral Artery Dissection*
Vertebral Artery*
Vertebrobasilar Insufficiency
Anticoagulants
Platelet Aggregation Inhibitors

Figure

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  FIGURE 1. Case 2. A 54-year-old woman with intermittent headache after swimming. A: Initial CTA showing fusiform aneurysm at left V4 segment. B: After 4 months, the aneurysm disappeared completely. CTA: computed tomographic angiography.

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  FIGURE 2. Case 4. A 56-year-old male with headache after a physical fight. A: Initial CTA showing fusiform aneurysm at left distal vertebral artery. B: After 5 months, increase in size and change in shape of the aneurysm from fusiform to globular. C: One month later, size of the aneurysm decreased reversely and its shape changed from globular to fusiform. D: The recent CTA, aneurysm became smaller. CTA: computed tomographic angiography.

Reference

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