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Vertebral Artery Dissection
Aka: Vertebral Artery Dissection, Vertebral Dissection, Vertebrobasilar Dissection
- See Also
- Cervical Artery Dissection
- Cerebrovascular Accident of Vertebral Artery
- Vertebral Artery Injury in Blunt Neck Trauma
- Carotid Artery Dissection
- Epidemiology
- Incidence: 1 to 1.5 per 100,000
- Cerebroarterial Dissections (Carotid Artery and Vertebral Artery) are uncommon (<2%) causes of Ischemic CVA
- Age
- Younger patients account for up to 25% of Vertebral Dissection related Ischemic CVA
- Peak Incidence age 50-60 years
- Gender
- Women are affected at a younger age than men
- Pathophysiology
- Vertebral Artery media tear (middle muscular, arterial layer) allowing blood intrusion into arterial wall
- Resulting intramural thrombus occludes vessel with risk of CVA
- Causes
- See Cervical Artery Dissection
- Types
- Ischemic Vertebral Artery Dissection
- Resulting cerebral ischemia or infarction
- Many dissections heal spontaneously and occluded vessels may be compensated by opposite Vertebral Artery
- Rupture of Intradural Vertebral Artery dissecting aneurysm (hemorrhagic)
- Subarachnoid Hemorrhage
- Unstable with high risk of recurrent bleeding (70% of cases, most within first week, and mortality 47%)
- Findings
- Extracranial Vertebral Artery Dissection (primarily at C1-2)
- Occipitocervical region severe pain
- Vertebrobasilar Ischemia or Infarction Symptom
- Dizziness
- Vertigo
- Diplopia
- Ataxia
- Dysarthria
- Vertebrobasilar Infarction
- Cerebellar infarction
- Wallenberg Syndrome
- Spinal Cord Infarction
- Intracranial Vertebral Artery Dissection
- Subarachnoid Hemorrhage in 50% of cases
- High rebleeding rate, poor prognosis, high mortality
- Responsible for up to 10% of non-Traumatic Subarachnoid Hemorrhage
- May be minor in some cases
- Imaging
- MR Angiogram
- Has largely replaced CT Angiogram as gold standard, with similar efficacy
- CT Angiogram
- As with MRA, CT angiogram has high Test Sensitivity
- Prognosis
- Extracranial Vertebral Artery Dissection
- No deficit 50%
- Mild deficit 21%
- Moderate to severe deficit 25%
- Mortality 4%
- Intracranial Vertebral Artery Dissection
- Associated with severe neurologic deficits
- Management
- Anticoagulation (unless contraindicated, e.g. Hemorrhage)
- Intravenous Heparin, then
- Oral Anticoagulant
- Surgical interventions
- Endovascular procedures
- Vascular or Neurosurgery
- References
- Park (2008) J Korean Neurosurg Soc 44:109-15 [PubMed]