[Prolonged headache six weeks before ischemic symptoms due to vertebral artery dissection--a case report]

A 43-year-old woman presented with weakness in her left arm and leg. She had noticed headache persisting for 2 weeks in her right occipital area 6 weeks prior to the onset of the weakness. Cranial diffusion-weighted MR image demonstrated acute infarction in the right medial part of medulla oblongata. Cerebral angiography revealed pearl and string sign in the right intracranial vertebral artery. Magnetic resonance T1-weighted image obtained when the patient complained of left-sided weakness showed a high intensity area in right vertebral artery corresponding to intramural hematoma. The diagnosis of spontaneous vertebral artery dissection was established based on clinical features, laboratory findings, MR images and angiographic findings. Generally, in patients with cervicocephalic artery dissection with ischemic onset, the occurrence of headache is either simultaneous with the ischemic symptoms, or several days prior to the ischemic symptoms. The present case showed that headache due to arterial dissection can occur several weeks prior the ischemic symptoms. Precise history of headache should be taken in patients with cervicocephalic artery dissection.