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[Extracranial vertebral artery dissection repeating distal embolism: case report]
Kenta Fujimoto1, Yasushi Shin, Jun-ichi Iida
1Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
No Shinkei Geka. Neurological Surgery
|April 16, 2005
Summary
Vertebral artery dissection can cause repeated strokes, even with anticoagulation. Embolization of the affected artery may be necessary to prevent further ischemic events.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- Vertebral artery dissection (VAD) is a significant cause of stroke in young adults.
- Cervical artery dissection accounts for approximately 2-3% of all strokes.
Observation:
- A 48-year-old male presented with neck pain and vertigo, progressing to cerebellar and occipital lobe infarction.
- Cerebral angiography confirmed left vertebral artery dissection with occlusion of the left posterior inferior cerebellar artery and right calcarine artery.
- Despite anticoagulation with heparin and aspirin, the patient developed contralateral cortical blindness due to embolism.
Findings:
- Successful thrombolysis was not achieved.
- Endovascular embolization of the dissected vertebral artery was performed to prevent further embolization.
- This case highlights the potential for recurrent embolism in VAD despite standard medical management.
Implications:
- The management of VAD with recurrent embolism requires careful consideration of treatment timing and modality.
- Endovascular intervention may be a viable option for selected cases of VAD with ongoing embolic risk.
- Further research is needed to establish optimal treatment guidelines for complex VAD presentations.