A case of unilateral vertebral artery dissection progressing in a short time period to bilateral vertebral artery dissection

Abstract

Background: Vertebral artery dissection (VAD) is an important cause of stroke in young and middle- aged people. Bilateral occurrence of VAD is generally considered rare, but the number of reports of bilateral VAD has been increasing in recent years. In this paper, we report a case of de novo VAD on the contralateral side presenting with subarachnoid hemorrhage in the acute stage of cerebral infarction due to unilateral VAD. Case Description: A 52-year-old man developed sudden-onset left occipital headache, dizziness, dysphagia, and right-sided hemiparesthesia and was admitted to our hospital. Head magnetic resonance imaging on admission showed a left lateral medullary infarction due to the left VAD. At this point, the right vertebral artery was normal. However, on day 9 after onset, he suddenly presented with subarachnoid hemorrhage due to the right VAD. Emergency endovascular treatment was performed for the dissecting aneurysm of the right vertebral artery. The patient’s condition improved gradually after the procedure, and he was discharged with a modified Rankin Scale score of 1. Conclusion: Bilateral occurrence of VAD may be more common than previously believed. Even in cases of unilateral VAD, we need to pay attention to the occurrence of de novo VAD on the contralateral side.

Reconstructive embolization for contralateral vertebral artery dissecting aneurysm that developed after internal trapping of ruptured vertebral artery dissection: A case report and literature review

“…To the best of our knowledge, only 17 other cases of progressing or de novo contralateral vertebral artery wall irregularity in patients with initial unilateral VAD or VADA have been reported [Table 1]. [3,5,6,8,10,[12][13][14][15] Interestingly, 17 cases (including the current one) were reported from Japan and one from Korea. We reviewed the first event and its treatment, progress, secondary event, the interval before the secondary event, category (de novo or progressing), and outcomes from the 18 reports.…”

A Case of Intracranial Vertebral Artery Dissection Undetected by CT, MRI, and MRA at the Onset of Headache That Caused Subarachnoid Hemorrhage Seven Days Later

“…As special cases, there have been a few reports of the appearance and bleeding of new contralateral VAD (contralateral de novo VAD) during treatment for initially unilateral VAD. In the report of a case of contralateral de novo VAD that developed SAH on the 9th hospital day during conservative treatment for VAD due to unilateral infarction of the medulla oblongata, 6) the following similarities to the present case were observed: 1) the contralateral VA was normal on MRA on the 1st and 4th hospital days, 2) the site of de novo VAD enlarged and ruptured in a short period, 3) the patient suddenly developed disturbance of consciousness at the time of rupture with no preceding clinical symptoms, and 4) no antithrombotic therapy was administered before rupture. The authors considered the possibility that small dissection of the vascular wall undetected by imaging studies enlarged later and resulted in rupture, and referred to the possibility of diagnosis by MRI BPAS or vessel wall imaging.…”

“… 8) For the diagnosis of VAD, MRI and MRA, which provide information about both the vascular lumen (e.g., luminal irregularity and intimal flap) and vascular wall (e.g., intramural hematoma), are considered useful. 9) There have been reports concerning sequences, including 3D-T1 weighted, 10) 3D-black blood T1 weighted, 9) fat-suppressed T1 weighted, 11) T2 weighted, 4) fat-suppressed T2 weighted, 11) proton-density weighted, 4 , 10) susceptibility weighted, 9) and BPAS, 6) and these modalities may be considered when VAD is suspected. The information obtained by CTA or DSA is limited primarily to the vascular lumen.…”

Case Report: De novo Vertebral Artery Dissection After Intravascular Stenting of the Contralateral Unruptured Vertebral Artery Aneurysm

“…There are only a few reports about the de novo VADA after treatment of the contralateral VA in the existing literature. Previously reported cases are summarized in Table 1 (11)(12)(13)(14)(15)(16)(17). Most initial aneurysms appear on the left side and manifest as SAH or infarction, and can be treated by trapping or occlusion of VA.…”