Spontaneous dissections of the vertebral arteries

Abstract

Clinical and angiographic features and outcome in 25 patients with spontaneous dissections of the vertebral arteries are described. Most patients were in their fourth or fifth decade of life, and women predominated. Forty-eight percent of the patients were hypertensive. Angiographic evidence of fibromuscular dysplasia was noted in one only. Brainstem ischemic symptoms (usually a lateral medullary syndrome) and ipsilateral occipital headache and neck pain (often preceding but sometimes associated with or following the brainstem ischemic event) were the most common clinical findings. The angiographic features in decreasing order of frequency were luminal stenosis (often irregular and tapered), aneurysm, occlusion, and intimal flap. On follow-up, most of the patients (88%) made complete or very good recoveries. Angiographic abnormalities either subsided or improved in 76%. Multivessel dissection (involvement of both vertebral arteries or one or both vertebral arteries and one or both internal carotid arteries) was noted in about two-thirds of the patients. This tendency of vertebral artery dissections to involve multiple cervicocephalic vessels concurrently, if not simultaneously, implies that four-vessel angiography should be attempted if a vertebral artery dissection is visualized. It also raises the possibility of an underlying arteriopathy that predisposes the vessel to dissection.

Clinical and Neuroradiological Features of Intracranial Vertebrobasilar Artery Dissection

“…[1][2][3][4][5][6] However, neurologists note that extracranial and intracranial vertebrobasilar artery dissections often cause brain stem ischemia or minor clinical symptoms, such as headache. 7,8 The clinical manifestations of intracranial vertebrobasilar artery dissection are still obscure, in part because neurosurgeons and neurologists have treated and described quite different groups of patients. New diagnostic methods for vertebrobasilar artery dissection in which MRI and MR angiography are used have been developed, 9 -15 but their clinical value has not been studied in patients with intracranial vertebrobasilar artery dissection.…”

Progression of Vertebral Artery Dissection: Vessel Wall Enhancement and Aneurysm Dilation

“…The natural course of unruptured intracranial vertebral artery dissection had been reported to be benign, with a high chance of spontaneous healing. 1,2 However, in this patient the dissection changed to saccular aneurysm type on follow-up contrast-enhanced MRI and DSA after nine months. The diameter of the dilated segment was also increased from 4 to 8 mm.…”

Dissecção da artéria basilar: relato de caso

“…As dissecções arteriais cérvico-cefálicas são analisadas em vários estudos [1][2][3][4][5][6][7][8] . Atingem comumente as artérias carótidas e são menos frequentes no território vertebrobasilar.…”

“…[1][2][3][4][5][6][7][8] As dissecções arteriais representam parte das etiologias definidas. Essas dissecções atingem as artérias carótidas e vertebrobasilares, sendo pouco frequentes neste último grupo, o envolvimento isolado da artéria basilar uma exceção.…”