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Unique Presentation of Vertebral Artery Dissection: A Case Report
Rossen I Kirkov1, Daniel Fisher1
1Trident Medical Center, Charleston, South Carolina.
HCA Healthcare Journal of Medicine
|July 11, 2025
Summary
Vertebral artery dissection (VAD) can mimic cerebral stroke. This case shows a patient with VAD presenting with focal deficits, treated successfully with thrombolytics, suggesting a potential new treatment approach for VAD.
Area of Science:
- Neurology
- Vascular Medicine
- Emergency Medicine
Background:
- Vertebral artery dissection (VAD) is a leading cause of stroke in young adults.
- VAD commonly presents with headache, neck pain, and posterior circulation stroke symptoms.
- Atypical presentations of VAD with focal neurologic deficits mimicking cerebral stroke are rare.
Observation:
- A 46-year-old woman presented with unilateral headache, neck pain, and acute onset of right-sided extremity weakness and numbness.
- Initial computed tomography angiography (CTA) showed a questionable VAD.
- The patient received tenecteplase (TNK) for suspected cerebral ischemia, leading to rapid symptom improvement.
Findings:
- Follow-up magnetic resonance imaging confirmed VAD but revealed no cerebral infarction.
- The patient's presentation mimicked cerebral stroke despite the underlying VAD.
- Treatment with TNK resulted in significant clinical improvement.
Implications:
- This case underscores the importance of considering VAD in patients with neck pain and neurologic deficits.
- The successful use of thrombolytics (TNK) in this VAD case adds to evidence supporting their use, despite a lack of official guidelines.
- This unique presentation and treatment outcome may influence future management strategies for VAD.
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