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1/110. Bilateral vertebral artery dissection causing a cerebrovascular accident in pregnancy. A case report.

    BACKGROUND: vertebral artery dissection, occurring spontaneously or following a traumatic event, is a cause of posterior circulation stroke in young individuals, including pregnant women. CASE: A 20-year-old, primagravid woman acutely developed headache, right-sided hemiparesis and parasthesias, and blurred vision. Within days she complained of cervical neck pain. magnetic resonance imaging findings were consistent with a posterior circulation cerebrovascular accident (CVA). An arteriogram, performed to exclude vasculitis, revealed bilateral vertebral artery dissection. No inciting event could be recalled. CONCLUSION: Vascular dissections occur rarely during pregnancy. Spontaneous extracranial vertebral artery dissection itself is very rare in general. Cerebral ischemia can follow vertebral artery dissection. In young patients with CVA, consideration of the diagnosis of vertebral artery dissection followed-by angiography and anticoagulation is an important component of the workup and care. ( info)

2/110. Spontaneous vertebral artery dissection mimicking acute vertigo. Case report.

    A patient with acute vertigo, and normal findings on neurologic examination, was found to have vertebral artery dissection (VAD). This case shows that the clinical picture of VAD can mimic vertigo of labyrinthine (i.e, peripheral) origin. ( info)

3/110. subarachnoid hemorrhage from vertebral artery dissecting aneurysms involving the origin of the posteroinferior cerebellar artery: report of two cases and review of the literature.

    OBJECTIVE AND IMPORTANCE: Few reports have been published on ruptured vertebral artery dissecting aneurysms in which the posteroinferior cerebellar artery (pica) arises from the aneurysm wall, and there is ongoing debate as to the proper management of this type of aneurysm. This article describes two patients. CLINICAL PRESENTATION: Both patients presented with subarachnoid hemorrhage and were admitted to our institution on the day of rupture. Computed tomography revealed that the subarachnoid hemorrhage was located mainly in the posterior fossa. cerebral angiography demonstrated a vertebral dissecting aneurysm involving the origin of the pica. In one patient, the pica was very large. INTERVENTION: One patient was treated by trapping, with the pica involved in the trapped segment. Postoperatively, the patient experienced transient mild hoarseness and dysphasia but recovered completely. The other patient, whose pica was very large, was initially treated by endovascular proximal occlusion. This resulted in marked enlargement of the distal part of the aneurysm, indicating a need for surgical treatment. A clip was applied to the origin of the pica after anastomosis of the occipital artery to the pica. The patient recovered well and was discharged with no neurological deficits. CONCLUSION: The ideal method of treatment for patients with dissecting aneurysms of the vertebral artery involving the pica origin is complete isolation of the aneurysm by trapping, with revascularization of the pica. However, trapping alone is one possible treatment option. If proximal clipping alone is carried out, follow-up angiography is mandatory to observe any changes in the aneurysm. ( info)

4/110. Complex traumatic dissection of right vertebral and bilateral carotid arteries: a case report and literature review.

    A 27-year-old female motorcycle passenger was admitted with bruises and concussion after a motor-vehicle accident. After a lucid interval of several hours she became stuporous and progressed to an acute comatose state. Computed tomography demonstrated extensive cerebral ischaemia in the territory of the right middle cerebral artery. Angiography after transfer to the authors' hospital revealed dissections of both carotid arteries and of the right vertebral artery. The patient underwent surgical reconstruction of the left internal carotid artery with saphenous vein. The management of this patient is discussed and the literature reviewed. ( info)

5/110. The usefulness of 3D-CT angiography for the diagnosis of spontaneous vertebral artery dissection-report of two cases.

    Spontaneous vertebral artery dissection (VAD) has been recognized as being more common than was first thought, with the growing use of magnetic resonance imaging (MRI). However, simple MRI alone is not always satisfactory for making an accurate diagnosis. We experienced two cases of VAD in our clinic, in which three-dimensional computed tomographic angiography (3D-CTA) was performed. Our scanner has the capability of examining a slice of 1mm thick, 0.5mm reconstruction pitch, and a scan time of 1s/rotation. 3D-CTA clearly demonstrated the stenotic change concomitant with the surrounding thrombus and was thought to be useful for making an accurate diagnosis. ( info)

6/110. The double lumen: a pathognomonic angiographic sign of arterial dissection?

    A case is reported which questions the absolute significance of the "double-lumen sign" in the diagnosis of arterial dissection. I suggest that when demonstrated in isolation, this sign should be interpreted with caution, giving consideration to the possibility of arterial fenestration, and appropriate diagnostic measures implemented. ( info)

7/110. Cerebellar hemorrhage after coil embolization for a ruptured vertebral dissecting aneurysm.

    BACKGROUND: We present a case of ruptured vertebral dissecting aneurysm that exhibited cerebellar hemorrhage after successful embolization of the vertebral artery including the dissected site. CASE PRESENTATION: A 59-year-old man suffered a sudden onset of severe occipital headache when he looked up. Computed tomography demonstrated subarachnoid hemorrhage. Angiography revealed a right vertebral dissecting aneurysm distal to the posterior inferior cerebellar artery. Endovascular embolization of the aneurysm was performed with preservation of the posterior inferior cerebellar artery. The next day, the patient suffered a cerebellar hemorrhage in the vermis. The intracranial pressure was controlled by external ventricular drainage. The patient was discharged with mild cerebellar ataxia and bilateral abducens nerve palsy. CONCLUSION: In a case of vertebral dissecting aneurysm distal to the posterior inferior cerebellar artery, blood circulation in the vertebral arterial system may change after embolization of the aneurysm. In our case, the preserved posterior inferior cerebellar artery might have been hemodynamically stressed postoperatively, resulting in cerebellar hemorrhage. Therefore, strict control of blood pressure is essential in the acute stage after occlusion of the aneurysm. ( info)

8/110. Extracranial vertebral artery dissection causing cervical root lesion.

    The authors report an unusual manifestation of extracranial vertebral artery dissection (VAD), presenting with a predominantly motor radicular manifestation. Cervical magnetic resonance imaging (MRI) revealed the intramural hematoma in the dissected vessel wall, compressing mainly the segmental motor root and, to a lesser degree, the sensory ganglion. In the digital subtraction angiography (DSA), a circumscribed narrowing of the incriminated vessel was demonstrated. color-coded Duplex imaging (CDDI) revealed complete recanalization after a few days of anticoagulation treatment. Complete neurologic recovery was seen after 3 months. Considering the MRI data, the likely pathogenetic mechanism was compression of the nerve root by the intramural hematoma. The synopsis with similar cases in the literature points to the characteristic features, i.e., the association of neck pain with radicular motor deficit and the absence of degenerative disk disease. The respective syndrome should raise the suspicion of vertebral artery dissection, especially in young individuals. ( info)

9/110. Recognizing vertebral artery dissection in children: a case report.

    vertebral artery dissection is an unusual cause of stroke especially in children. The majority of dissections are thought to be caused by trauma although in many cases the trauma may be trivial. In other cases, certain underlying pathological processes are thought to be risk factors. We report a case of vertebral artery dissection in a 9-year-old child who presented with neurologic deficits suggestive of a posterior circulation stroke. The signs and symptoms of this unusual entity can be subtle and intermittent over a period of days to weeks; thus, making it very difficult to recognize. Therefore, it is important to consider the possibility of vertebral artery dissection in the differential diagnosis of neurologic deficits in children. ( info)

10/110. Embolic cerebellar infarction caused by spontaneous dissection of the extracranial vertebral artery--two case reports.

    Spontaneous dissection of the extracranial vertebral artery (VA) may cause ischemic stroke in the posterior circulation. A 22-year-old female and a 38-year-old male presented with sudden onset of vertigo and nausea without trauma. Angiography was initially interpreted as normal, but retrospective examination disclosed extracranial VA dissection in the V3 segment in both cases. Arterial dissection resulting in embolic stroke in the territory of the ipsilateral posterior inferior cerebellar artery was highly suspected. Both patients were treated conservatively without sequelae. Careful angiographic interpretation is important for the diagnosis of extracranial VA dissection. Spontaneous extracranial VA dissection should be suspected in young patients presenting with ischemic stroke but without predisposing risk factors or associated trauma. ( info)
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