Stroke, Vol 18, 1037-1047, Copyright © 1987 by American Heart Association
JL Mas, MG Bousser, D Hasboun and D Laplane
Clinical and radiologic findings in 13 patients (11 women, 2 men) with
extracranial vertebral artery dissection are reported. Dissection was
spontaneous in 8 patients, occurred after neck manipulation in 2 and after
a potential minor injury to the neck in 3. Six had a history of common
migraine, 4 were using oral contraceptives at the time of dissection, and 3
had fibromuscular dysplasia. Dissection was bilateral in 8 patients and
associated with carotid dissection in 3. It usually presented with neck or
occipital pain preceding basilar ischemic symptoms by a few minutes to 1
month. In 3 patients, transient ischemic attacks were the only
manifestation of basilar ischemia, and in 1 patient there was no symptom of
basilar ischemia despite bilateral vertebral dissection. In 19 of the 21
dissected vertebral arteries, the angiographic appearance was that of an
irregular stenosis, which was associated in 6 arteries with
pseudoaneurysmal formation. In 2 patients, 1 vertebral artery was occluded
but the contralateral artery showed the typical irregular stenosis. The
dissection involved only the third segment in 33%, only the second segment
in 24%, and 2 or more segments in 38%. Eleven patients were treated with
anticoagulants and 2 with aspirin; 11 recovered without sequelae and 2 had
residual deficit. No recurrence was observed (mean follow-up 34 months). At
control angiography (n = 12) or ultrasonic study (n = 1), 63% of dissected
vertebral arteries had returned to normal, 26% showed marked improvement,
and 11% were occluded. Our patient characteristics are compared with those
of previously published cases. The validity of the distinction between
spontaneous dissection and dissection associated with minor trauma is
discussed.
ARTICLES
Extracranial vertebral artery dissections: a review of 13 cases
Service de Neurologie, Centre Raymond Garcin, Hopital Sainte-Anne, Paris, France.
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