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Early detection of vertebral artery dissection
Alice Morag MacArthur1, Syed Mehdi1
1Acute Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
BMJ Case Reports
|December 21, 2018
Summary
A fall triggered a vertebral artery dissection and a middle cerebral artery aneurysm in a 36-year-old woman. Prompt diagnosis via CT angiogram led to conservative management with aspirin and outpatient follow-up.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Cerebral artery dissections and aneurysms are rare but serious vascular events.
- Traumatic injuries, including falls, can precipitate arterial dissection.
- Aneurysms may coexist with dissections, necessitating comprehensive vascular assessment.
Observation:
- A 36-year-old female presented with a week of occipital headache after a fall.
- Physical examination findings were unremarkable.
- Computed tomography (CT) angiography revealed a right vertebral artery dissection and a left middle cerebral artery aneurysm.
Findings:
- The vertebral artery dissection measured 1 cm.
- The middle cerebral artery aneurysm measured 3 mm.
- The patient was managed conservatively with aspirin.
Implications:
- This case highlights the importance of considering vascular injury after head trauma, even with normal initial examinations.
- CT angiography is crucial for diagnosing complex cerebrovascular pathologies like dissection and aneurysm.
- Conservative management with antiplatelet therapy can be a viable option for select cases of vertebral artery dissection.
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