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Published on: September 25, 2009
Vertebral artery anomaly with atraumatic dissection causing thromboembolic ischemia: a case report
R S Jackson1, A H Wheeler, B V Darden
1Charlotte Spine Center, Charlotte, North Carolina 28207, USA.
Spine
|July 26, 2000
Summary
A rare case of atraumatic vertebral artery dissection occurred due to an unusual C3 entry point, triggered by normal neck movements. Standard arteriography is crucial for diagnosing such vertebral artery pathologies when other imaging fails.
Area of Science:
- Neurology
- Vascular Anatomy
- Radiology
Background:
- The vertebral artery typically enters the transverse foramen at C6, with rare variations at C5 or C4.
- A previous case reported C3 entry associated with severe neurological deficits.
- This report details a 27-year-old woman with migraines experiencing neurological symptoms linked to neck and arm movements.
Observation:
- Anomalous vertebral artery entry into the C3 transverse foramen was identified.
- Magnetic resonance angiography (MRA) was initially inconclusive.
- Standard cervico-cerebral arteriography revealed focal dissection at C4 and thromboembolic complications.
Findings:
- Atraumatic vertebral artery dissection can result from anomalous anatomy and physiologic motion.
- Standard arteriography is superior to MRA in diagnosing this rare condition.
- Anticoagulation led to the resolution of neurologic symptoms.
Implications:
- Vertebral artery dissection should be considered in patients with neurological symptoms and cervical movements, even without trauma.
- Inadequate visualization by MRA necessitates prompt standard arteriography for suspected vertebrobasilar thromboembolic ischemia.
- Understanding vertebral artery anatomy is key to preventing and diagnosing such dissections.
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