Vertebral Artery Dissection

vertebral artery dissection

This 32 year-old male presented with neck pain, vertigo and vomiting.

The axial diffusion-weighted image (inset) shows restricted diffusion in the right cerebellum consistent with an infarct. The infarct is in the territory of the posterior inferior cerebellar artery. Note sparing of the lateral medulla (also PICA territory).
The axial T1-weighted, fat-saturated image of the neck (main image), shows high signal in the location of the right vertebral artery (click image for arrow), consistent with dissection. Magnetic resonance angiography of the extracranial cerebral vessels (not shown) demonstrated reduced flow in the right vertebral artery.

Cranial artery dissection may be due to: trauma or cervical manipulation; hypertension; migraine; vigorous physical activity (eg weightlifting); vasculopathy such as fibromuscular dysplasia or Marfan’s syndrome; or sympathomimetic drug abuse. Arterial dissection may also be idiopathic.

The principle complications are stroke and transient ischaemic attack, due to embolisation of thrombus and to vessel narrowing. When there is intracranial extension, there may also be subarachnoid haemorrhage. Management is usually by anticoagulation to prevent thromboembolic complications.

References:
Osborn A. Diagnostic Neuroradiology. Mosby 1994.
Grossman RI, Yousem DM. Neuroradiology: The Requisites. 2nd edition. Mosby 2003.

Credit: Dr Laughlin Dawes, ..