Vertebral artery dissection

Case contributed by Dr Bruno Di Muzio


Sudden collapse with right sided headache while doing sports activities. Right neck pain last night.

Patient Data

Age: 25 years
Gender: Female

CT Brain and CTA Neck and Brain

No acute intracranial hemorrhage or established acute cortical infarct. Grey-white differentiation is maintained.

There is a dissection of the right vertebral artery from the V2 segment at the C2-3 level, extending into the V3 and V4 segments. The distal-most segment of the right V4 vertebral artery backfills from the left vertebral artery. There is a filling defect in the tip of the basilar artery, extending into the proximal P1 segment of the right posterior cerebral artery. The posterior cerebral artery distal to this opacifies normally, with some supply being derived from the right foetal PCOM. Normal opacification of the left PCA. The remainder of the intracranial circulation opacifies normally, with no filling defects, stenoses or vascular malformations.


MRI Brain

There is an established infarct involving the superior aspects of the right cerebellar hemisphere and lateral pons. Note the occlusion and absence of flow void within the imaged distal V4 segment od the right vertebral artery. 

Case Discussion

This case demonstrates a spontaneous right sided distal vertebral artery dissection evolving to complete occlusion of the segment and posterior fossa infarcts. 

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Case information

rID: 54478
Published: 12th Jul 2017
Last edited: 16th Apr 2020
Tag: rmh
Inclusion in quiz mode: Included

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