Images in clinical medicine: vertebral artery dissection

ABC ARTICLE

Images in clinical medicine: vertebral artery dissection

Laith Alrubaiy*

Ysbyty Gwynedd North Wales NHS Trust, Bangor LL57 2PW, UK

Received: 23 May 2009; Accepted in revised form: 10 June 2009; Published: 11 January 2010

Citation: Libyan J Med 2010, 5: 4633 - DOI: 10.4176/090706

Libyan J Med 2010. © 2010 Laith Alrubaiy. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Vertebral artery dissection

This is a case of a 47-year-old German lorry driver with very limited English who presented with sudden onset of a neck pain followed by an occipital headache while he was on the motorway. The pain forced him to stop his vehicle and call a friend who brought him to accident and emergency department. On examination, he had unsteady gait, slight dysarthria and subtle horizontal nystagmus on extreme left gauze. There was slight incoordination and dysdiadokinesis in his left upper limb. Lumbar puncture showed high CSF protein with normal cells and glucose. MRI scan showed a left cerebellar infarction (Fig. 1). On angiogram (Fig. 2), there was evidence of some irregularity of the superior vertebral arteries bilaterally, particularly on the left side. There was some high signal in the vessel wall on the left side. These findings are consistent with vertebral arteries dissection predominantly on the left side.


Fig. 1.  MRI scan showing a left cerebellar infarction.


Fig. 2.  Carotid angiogram showing irregularity of the superior vertebral arteries mainly on the left.

Learning points

    1) Vertebral artery dissection can present with subtle clinical findings (1).

    2) Vertebral artery dissection is one of the causes of an isolated rise in CSF protein (2).

References

  1. Ramphul N, Geary U. Caveats in the management and diagnosis of cerebellar infarct and vertebral artery dissection. Emerg Med J. 2009; 26: 303–4. [Crossref]
  2. Umasankar U, Carroll TJ, Famuboni A, Patel MD, Starke ID. Vertebral artery dissection: not a rare cause of stroke in the young. Age Ageing. 2008; 37: 345–6. [Crossref]

*Laith Alrubaiy
Ysbyty Gwynedd North Wales NHS Trust
Bangor LL57 2PW, UK
Email: laithalrubaiy@gmail.com

Refbacks

  • There are currently no refbacks.
Bookmark and Share


Libyan Journal of Medicine eISSN 1819-6357, ISSN 1993-2820

This journal is published under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License. Responsible editor: Omran Bakoush