[Vertebral artery dissection. Clinical aspects, non-invasive diagnosis, therapy--observations in 14 patients]

We report 14 patients with so called spontaneous vertebral artery dissection. Dissection site was the atlanto-axial (V3) segment in 12 patients, the intertransverse (V2) in 5 and the intracranial (V4) in 3. Two had additional carotid artery dissection. Typical clinical presentation of symptoms consisted in unilateral, acute, severe neck and occipital head pain (12/14) simultaneously with, or followed by signs of vertebrobasilar ischemia (12/14). The later may be Wallenberg's syndrome (7/14), a cerebellar (5/14) or a vestibular syndrome. When this constellation is present in a young patient and preceded by a "trivial" head or neck trauma dissection should be suspected in cases without vascular risk factors. According to our results, MRI today is the method of choice to confirm diagnosis. Mural hematoma can be shown non invasively (12/13). Angiography is only rarely indicated. Doppler- and duplex sonography of posterior circulation is more difficult and results are less conclusive than with the carotid system. Nevertheless, we found abnormal results in 86% and definite pathologic results in 64% of our patients when combining both methods. Immediate anticoagulation appears to be an adequate treatment when intracranial dissection is excluded. Its effectiveness, however, has not been demonstrated. None of the 12 anticoagulated patients showed deterioration.