A Routine Neck Massage, a Devastating Stroke: Imaging Clues to Vertebral Artery Dissection

Area of Science:

• Neurology
• Vascular Imaging
• Trauma Care

Background:

• Cervical trauma can lead to serious vascular complications.
• Neurological symptoms following neck injury warrant thorough investigation.
• Vertebral artery dissection (VAD) is a potential cause of such symptoms.

Purpose of the Study:

• To highlight the importance of considering VAD in young adults with neurological deficits after neck trauma.
• To compare the diagnostic efficacy of high-resolution magnetic resonance angiography (HR-MRA) and CT angiography (CTA) in diagnosing VAD.

Main Methods:

• Retrospective analysis of patients with neurological symptoms post-neck trauma.
• Comparison of imaging findings between HR-MRA and CTA.
• Focus on cases with thrombosed false lumen in VAD.

Main Results:

• HR-MRA demonstrated superior sensitivity and specificity in detecting VAD compared to CTA, particularly when the false lumen was thrombosed.
• CTA may miss dissections with intraluminal thrombus, leading to underdiagnosis.
• Early and accurate diagnosis is crucial for timely intervention.

Conclusions:

• Vertebral artery dissection should be strongly considered in the differential diagnosis of young adults presenting with neurological symptoms after neck trauma.
• High-resolution magnetic resonance angiography is the preferred imaging modality for diagnosing VAD, especially in the presence of a thrombosed false lumen.
• Accurate imaging is critical for appropriate management and improved patient outcomes.