Lessons from the diagnosis and treatment of spontaneous vertebral arterial dissection. Case report

Abstract

A 36-year-old man presented a sudden left occipital headache and right limb weakness after tooth-brushing. Conventional catheter digital subtraction angiography (DSA) showed a left VA occlusion at the crotch of the posterior inferior cerebellar artery. Four days later, the patient got worse. The angiogram showed the left vertebral artery had reopened and the basilar trunk occluded above the AICA. He died two days later and autopsy demonstrated a dissection of the basilar arteries. Based on the autopsy data from the patient in this study, we suggest that the BA dissection might be due to left VA dissection, and placing a stent on the juncture between the uninjured VA and the basilar trunk might be an effective method to prevent fatal BA occlusion.

Figure 1

A-H) Axial MR image showing abnormality of left vertebral artery (white arrow) and infarction of left bulb and cerebellum (black arrow). A-D) T1-weighted MR image. E-H) T2-weighted MR image.

Figure 2

DSA results on day 3 post admission. Left panel, a left VA occlusion at the crotch of the posterior inferior cerebellar artery (arrow). Right panel, the blood supply was partly compensated by the right anterior inferior cerebellar artery (arrow).

Figure 3

DSA display of BA trunk occlusion after consciousness disturbance of the patient on day 7 post admission.

Figure 4

Autopsy and pathologic examination. Left panel, autopsy of the patient, showing the thrombosis in the vertebrobasilar arteries. Right panel, pathologic examination, demonstrating the vascular occlusion and thrombosis between the tunica media and tunica adventitia in the upper segment of BA.

Figure 5

Schematic diagram of stent placement to prevent the progression of thrombus or dissected lesion from vertebral artery to basilar artery.