CV
Vertebral Artery Dissection
search
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 Dissection
s (
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-
Trauma
tic
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]
Type your search phrase here