Clinical Features of Vertebral Artery Dissection Accompanied Only by Pain: Clinical Course of Varicose Deformity

Abstract

Objective: Vertebral artery dissection (VAD) accompanied only by pain has a favorable prognosis. However, treatment intervention is required if it exacerbates with varicose deformity because subarachnoid hemorrhage (SAH) is more likely to occur. Herein, the clinical features of VAD accompanied only by pain were investigated. Methods: The subjects were 112 patients (74 men and 38 women) who developed a VAD accompanied only by pain. Their ages ranged from 18 to 77 years (mean, 49 years). The observation period ranged from 77 days to 115 months (mean, 38 months). The subjects were divided into three groups based on the initial radiographic findings: fusiform dilatation (FD), narrowing or occlusion (N/O), and pearl and string sign (PSS). The clinical course, time course of the imaging findings, surgical treatments, and outcomes were examined. Results: During the clinical course, SAH (2 cases), ischemia (2 cases), and contralateral dissection (4 cases) were observed. The 112 patients were classified as FD (35 cases), N/O (31 cases), and PSS (46 cases). During the clinical course, the imaging findings improved in 69 cases, remained the same in 2 cases, and became exacerbated in 41 cases. Of these 41 patients, 17 showed varicose deformity and 1 received treatment intervention. The remaining 16 patients subsequently showed improvement/no change on imaging (13 cases), occlusion (1 case), and further enlargement of the varicose deformity (2 cases). Of the two subjects with enlarged varicose deformities, one received treatment intervention and the other showed occlusion on imaging. Six patients received treatment interventions: SAH (2 cases), progression of dissection (1 case), exacerbation of imaging findings (2 cases), and enlargement of varicose deformity (1 case). All these patients had a good prognosis. Conclusion: Even in exacerbated cases, varicose deformities showed a low rate of rupture at 2 weeks and predominantly showed improvement on imaging. Therefore, treatment interventions should be carefully considered.