Unique Presentation of Vertebral Artery Dissection: A Case Report

Vertebral artery dissection (VAD) is a common cause of stroke within the younger patient population. It is usually associated with headache or neck pain, as well as signs and symptoms of a posterior circulation stroke, such as vertigo, dysarthria, and ataxia. However, there are very scarce reports of patients with this pathology presenting with focal neurologic deficits, which are more indicative of a cerebral stroke.

This case involves a 46-year-old woman who presented to the emergency department (ED) with complaints of right-sided headache and neck pain, which had been ongoing for 1 week, with newly developed right upper and lower extremity weakness and numbness 2.5 hours prior to arrival. There was a questionable finding of a VAD on the initial computed tomography angiography (CTA). Tenecteplase (TNK) was administered, and the patient's symptoms improved rapidly. Follow-up magnetic resonance imaging showed no evidence of cerebral infarction but did confirm the VAD. The patient was eventually discharged on antiplatelet therapy.

Vertebral artery dissection is an important diagnosis to consider in a patient presenting to the ED with neck pain and associated neurologic deficits. However, the patient's deficits in this scenario were more consistent with cerebral ischemia, and with a questionable CTA finding of dissection, the patient was treated with TNK. Currently, no official guidelines exist to recommend treatment of VAD with thrombolytics, as no randomized controlled trial has been done to show this is an effective and safe treatment. This case highlights a unique presentation of a VAD and adds to the growing support of using thrombolytics to treat VAD.