Extracranial dissection is easily diagnosed
by ultrasound
Vertebral Artery Dissection (VAD)
– 43% of are spontaneous in nature
– 31% are associated with cervical spine
manipulation
– 16% from trivial trauma
– 10% from major trauma
Haldeman et al. Spine. 1999; 15: 24: 785-94.
VAD
• Relatively rare.
(1966-2007=34 studies, 762 pts of VADJNNP,2008)
• Presenting symptoms:
– Unilateral posterior headache
–
–
–
–
–
• Pain may radiate to neck and
face
Dysarthria
Dysphagia
Ataxia
Double vision
Limb or trunk numbness
(Caplan et al.1985)
VAD
• Anatomical level:
Segment III (petrous level)
• From the superior of C2
foramen to the dura, most of
the spontaneous dissected
region.
• Can extended to segment
IV(upstream) with neurological
s/s.
• Most injured rotated point.
Segment I: Rises from the
Subclavian artery to the
transverse foramen of C6
Segment II: Within the
transverse foramina from
C6-C2
(the most massage injured level)
Segment IV: From the dura
into the cranium
Vertebral Artery Dissection Presenting Findings
and Predictors of Outcome
V1= 20%
Younger age+
V2 =35%
Low NIHSS score
V3 =34%
=> are good
V4= 11%
prognostic outcome
(Stroke, 2006)
VAD
• Diagnosis is same as in
carotid dissection.
• Treatment includes early
anticoagulation or
followed by anti-platelet
therapy.
• Account for 20 % of stroke younger than 45 yrs old.
• 70-80% of extracranial carotid, 15% of extracranial VA.
• Trauma, respiratory infection, underlying arteriopathy played some roles in
etiology.
• Local pain, headache, and ipsilateral Horner’s- s/s of Triad.
• Hours before retina or cerebral stroke.
• Prognosis is much better in extracranial than intracranial dissection.
• Recurrence is rare.
• SAH can be happened in intracranial dissection sometimes.
• Anti-platelet or anti-coagulation equally.