Multiple hereditary exostoses and stroke due to vertebral artery dissection

Area of Science:

• Neurology
• Vascular Surgery
• Genetics

Background:

• Multiple hereditary exostoses (MHE) is a rare genetic disorder characterized by numerous bone outgrowths.
• Vascular complications are uncommon in MHE patients.
• Vertebral artery dissection (VAD) is a potential cause of ischemic stroke.

Observation:

• A 39-year-old male with a history of MHE and a family history of the condition presented with sudden onset left-sided ataxia and hypoesthesia.
• The neurological symptoms were attributed to a left lateral medullary infarction.
• Imaging revealed a stenotic-pattern vertebral artery dissection (V1-V4) as the cause of the infarction.

Findings:

• This case represents a rare instance of vertebral artery dissection in a patient with multiple hereditary exostoses.
• The dissection occurred in the V1-V4 segments of the vertebral artery.
• A nonspecific relationship between MHE and vertebrobasilar dissection has been suggested.

Implications:

• This case expands the differential diagnosis for neurological complications in MHE patients.
• It underscores the importance of considering vascular causes, specifically VAD, in MHE patients presenting with neurological deficits.
• Further research may elucidate potential underlying mechanisms linking MHE and arterial dissection.