Skip to main content Accessibility help
×
Home

Contents:

Information:

  • Access

Actions:

      • Send article to Kindle

        To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

        Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

        Find out more about the Kindle Personal Document Service.

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

        Send article to Dropbox

        To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

        Send article to Google Drive

        To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

        Progression of Vertebral Artery Dissection: Vessel Wall Enhancement and Aneurysm Dilation
        Available formats
        ×
Export citation

A 35-year-old female with right ptosis and right facial and left limb paraesthesia visited our emergency room. Initial diffusion-weighted MRI revealed right lateral medullary infarct. Digital subtraction angiography (DSA) demonstrated dissection of pearl-and-string type involving a segment including a posterior inferior cerebellar artery (PICA) origin of the right distal vertebral artery. 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. Furthermore, wall enhancement was noted in the dissected arterial wall. The wall enhancement in the cervical artery dissection has been reported to be suggestive of inflammation and mostly resolve within six months. 3 Vessel wall enhancement can also be seen in such other arterial diseases as atherosclerosis, moyamoya disease and vasculitis. 4 Nevertheless, taking account of the change in geometry and the persistent vessel wall enhancement together, we concluded that the dissection had progressed despite conservative treatment. Thus, stent-assisted coil embolization was performed in the patient without complication.

Disclosures

SL, HSC, JJ, SLJ, KJA, BK, JK, and YSS hereby declare that they have no conflicts of interest to disclose.

Fig. 1 Initial MRI and DSA. Diffusion-weighted image (A) shows hyperintensity in right lateral medulla, suggestive of acute infarction. Magnetic resonance angiography (MRA) source image (B) and three-dimension (3D) rotational reconstructed image of DSA (C) show focal stenosis and fusiform dilatation (arrow) at distal vertebral artery, proximally to origin of PICA (arrowhead).

Fig. 2 Six-month follow-up MRI and DSA of the same patient. 3D-SPACE (A) shows wall enhancement (arrow) of dissecting aneurysm. MRA source image (B) and 3D-rotational reconstructed image of DSA (C) show interval change of saccular aneurysm formation at distal vertebral artery (arrow), proximally to PICA origin (arrowhead).

References

1. Mokri, B, Houser, OW, Sandok, BA, Piepgras, DG. Spontaneous dissections of the vertebral arteries. Neurology. 1988;38:880-885.
2. Arnold, M, Bousser, MG, Fahrni, G, Fischer, U, Georgiadis, D, Gandjour, J, Benninger, D, et al. Vertebral artery dissection: presenting findings and predictors of outcome. Stroke. 2006;37:2499-2503. Epub ahead of print Sep 7.
3. Pfefferkorn, T, Saam, T, Rominger, A, Habs, M, Gerdes, LA, Schmidt, C, et al. Vessel wall inflammation in spontaneous cervical artery dissection: a prospective, observational positron emission tomography, computed tomography, and magnetic resonance imaging study. Stroke. 2011;42:1563-1568. Epub ahead of print Apr 21.
4. Choi, YJ, Jung, SC, Lee, DH. Vessel wall imaging of the intracranial and cervical carotid arteries. J Stroke. 2015;17:238. Epub ahead of print Sep 30.