Ewha Med J.  2014 Mar;37(1):41-45. 10.12771/emj.2014.37.1.41.

Vertebral Artery Dissection Presented with Monoplegia by Cervical Radiculopathy

• Kim SH
• Yun JY
• Park KD
• Jeong JH

• KMID: 2171273
• DOI: http://doi.org/10.12771/emj.2014.37.1.41

Abstract

Vertebral artery dissection (VAD) is one of important causes of posterior circulation strokes in young age patients. Typical presentations of VAD are occipital headache or posterior neck pain, with various signs arising from brainstem or cerebellar infarctions. Muscular weakness or sensory change of an ipsilateral arm owing to cervical nerve root involvement in association with the VAD has been reported very rarely. Herein we describe two unusual manifestations of extracranial VAD, which presented with monoplegia of single upper limb.

Keyword

Vertebral artery dissection; Monoplegia; Radiculopathy

MeSH Terms

Arm
Brain Stem
Headache
Hemiplegia*
Humans
Infarction
Muscle Weakness
Neck Pain
Radiculopathy*
Stroke
Upper Extremity
Vertebral Artery Dissection*
Vertebral Artery*

Figure

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  Fig. 1 (A) T1 weighted and (B) T2 weighted C-spine magnetic resonance imaging (MRI) of patient 1. Cervical MRI study shows high and isosignal intensity of the wall thickening in left vertebral artery (arrow) and combined luminal narrowing. Definite spinal cord lesion is not observed.

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  Fig. 2 Three-dimensional computed tomography angiography of patient 1. Compared with a diameter of the right vertebral artery, left vertebral artery at the levels from the C6 to the C2 (arrow) is diffusely narrowed.

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  Fig. 3 Cerebral angiography of patient 1. Cerebral 4-vessel angiography shows diffuse narrowing of left vertebral artery (A. arrow) compared with the diameter of right vertebral artery (B). These results are suggestive of left vertebral artery dissection.

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  Fig. 4 (A) T1 weighted and (B) T2 weighted cervical spine MRI images of patient 2. In T1 weighted image, signal voiding of right vertebral artery (arrow) is narrower than that of left vertebral artery. Thickening with high signal intensity (arrow) is also noted on T2 weighted image.

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  Fig. 5 Cerebral angiography of patient 2. This study reveals the luminal irregularity and narrowing of right vertebral artery (A, arrow) compared with the diameter of left vertebral artery (B), which are compatible with the arterial dissection.

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  Fig. 6 Follow-up 3-dimensional computed tomography (CT) angiography of patient 2. After anticoagulation treatment, reconstructed cerebral CT angiography shows a recovery of the luminal narrowing of right vertebral artery (arrow).

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