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Vertebral artery dissection not detected by initial angiography--case report
Y Kurokawa1, S Abiko, T Okamura
1Department of Neurosurgery, Ube Industries Central Hospital, Yamaguchi.
Neurologia Medico-Chirurgica
|February 1, 1997
Summary
Vertebral artery dissection can cause subarachnoid hemorrhage. Repeat angiography and MRI in the subacute stage help diagnose "angiogram-negative" cases, revealing subtle vertebral artery changes.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroradiology
Background:
- Subarachnoid hemorrhage (SAH) is a critical neurological emergency.
- Identifying the source of SAH is crucial for appropriate management.
- Vertebral artery dissection is an important, though sometimes occult, cause of SAH.
Observation:
- A 57-year-old male presented with SAH.
- Initial cerebral angiography revealed minimal caliber change and reduced contrast density in the V4 segment of the vertebral artery.
- A repeat angiogram on day 14 demonstrated clear segmental narrowing, indicative of dissection.
Findings:
- The initial angiogram may not detect subtle signs of vertebral artery dissection.
- Serial imaging, including angiography and magnetic resonance imaging (MRI), is valuable in the subacute phase.
- These advanced imaging techniques can identify evolving changes characteristic of dissection.
Implications:
- Repeat angiography and MRI are essential for diagnosing "angiogram-negative" SAH.
- Early identification of vertebral artery dissection improves patient outcomes.
- This approach enhances the diagnostic yield for cerebrovascular events.