[Spontaneous dissection of the vertebral artery]

Spontaneous dissection of the vertebral artery (VA) is an infrequent cause of vertebral-basilar ischaemia in children and young adults, being responsible for 4% of cases of ischaemic infarct in this age group. The distinction between spontaneous dissection and traumatic dissection helps to clarify its vascular tendency, not brought on by laceration of the vessel wall secondary to traumatism. It appears clinically with neck pain and/or headache, followed by a clinical picture of ischaemia in the vertebral-basilar area. Diagnosis is based on clinical suspicion and identification of the angiographic signs of dissection prognosis is favourable with good recuperation in 88% of cases and low recurrence risk. We present a series of seven patients with ischaemic stroke of the brainstem brought about by spontaneous VA dissection. We studied the patients using computerized tomography (CT) scan, magnetic resonance (MR) and brain angiography. The group comprised six men and one woman aged from 9 to 44 years. In one case localization was intracranial, in five there was earlier arterial pathology (hypoplasia or dysplasia) and in the remaining case dissection was bilateral. After a long-term follow-up of between one and seven years, not one of our patients showed any recurrence of ischaemic signs. We would suggest that spontaneous VA dissection should be considered in differential diagnosis in clinical pictures of vertebral-basilar ischaemia in children and young adults since most probably its frequency is greater than that currently supposed. The discussed data would support underlying arterial pathology as a tendency factor.