Vertebral artery dissection stroke in evolution presented with postural headache as initial manifestation.

Area of Science:

• Neurology
• Vascular Neurology
• Radiology

Background:

• Acute ischemic brain infarction in young adults commonly results from arterial dissections or cardiogenic embolic stroke.
• Vertebral artery dissection is an uncommon cause of stroke in young individuals, particularly without a history of trauma.
• Postural headache is an atypical presentation for vertebral artery dissection, often leading to misdiagnosis as spontaneous intracranial hypotension.

Purpose of the Study:

• To describe a rare case of vertebral artery dissection presenting with acute postural headache and evolving stroke in a young adult.
• To emphasize the diagnostic challenges and the importance of considering cranial artery dissections in young stroke patients with atypical presentations.

Main Methods:

• Case report of a 37-year-old male presenting with acute onset postural headache and stroke.
• Initial diagnosis based on brain magnetic resonance imaging (MRI) suggesting an ischemic lesion.
• Utilized single-photon emission computed tomography (SPECT) to differentiate lesion type and confirmed lateral medullary syndrome on follow-up brain MRI.

Main Results:

• The patient experienced an acute onset of postural headache and a stroke in evolution.
• Initial MRI findings were misleading, but SPECT imaging helped clarify the lesion as ischemic/hemorrhagic.
• Lateral medullary syndrome was confirmed, and the patient improved with rehabilitation and aspirin therapy.

Conclusions:

• Cranial artery dissections should be a critical differential diagnosis for thunderclap headaches, even with postural changes and initially subtle neurological deficits in young adults.
• This case underscores the importance of considering rare etiologies and utilizing advanced imaging techniques for accurate diagnosis and management of stroke in young populations.