Vertebral artery dissection

Case contributed by Dr Maria Zakharkina

Presentation

Severe neck and head pain. No history of trauma. Complains of a headache for 5-6 years, over the past day the pain increased.

Patient Data

Age: 40 years
Gender: Female
Modality: Ultrasound

Figure 1: normal ultrasound findings of the right vertebral artery on the ostium (V1 segment).

Figure 2: thickening of the vascular wall of the vertebral artery in the segment at the entrance to C6.

Figure 3: thickening of the vascular wall of the vertebral artery in the segment at C5-C6.

Figure 4: significant expression of asymmetric thickening of the vascular wall of the vertebral artery in the segment at C4-C5.

Case Discussion

Оn the basis of these findings, the diagnosis of dissection was suggested (intravascular echoes, expansion of the arterial lumen in the V2 segment and the normal diameter of the ostium). We felt that the age of the patient and the expansion of the arterу due to the intravascular echoes essentially excluded arteritis or thrombosis of the artery. 

In this case, MRI was performed to verify the diagnosis which, however, did not show intramural hematoma on T1 fat saturated sequences. But according to M. Habs, et al, signal intensities of hematoma in cervical artery dissection vary over time, and it can be normal in the acute stage1

In the studу J. García-García vertebral arteritis is characterised by concentric, homogeneous and hypoechogenic mural thickening2. In this case, exhibited significant expression of asymmetric thickening and on certain locations of artery's lesion. 

Diagnosis of dissection was finally confirmed on a repeat MRI 7 days later, which showed the presence of an intramural haematoma.

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Case Information

rID: 51064
Case created: 2nd Feb 2017
Last edited: 4th Feb 2017
Inclusion in quiz mode: Included

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