Vertebral artery dissection

Case contributed by Dr Bruno Di Muzio

Presentation

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

Patient Data

Age: 25 years
Gender: Female
CT

CT Brain and CTA Neck and Brain

No acute intracranial haemorrhage 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

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. 

PlayAdd to Share

Case information

rID: 54478
Case created: 11th Jul 2017
Last edited: 18th Jul 2017
Tag: rmh
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.