A 25-year-old healthy young woman twisted her neck while being turned over by a big wave on a summer holiday in Spain. Returning home, she went to see a doctor for diffuse right-sided neck pain and dizziness, that had started with the accident. She was referred for an MRI of the cervical spine.
Routine sagittal and transverse, T1-weighted MRI were done.Contrast-enhanced MR-angiography of the supra-aortic arteries performed afterwards.


What is the diagnosis?

ANSWER

Traumatic vertebral artery dissection

Sagittal and transverse, T1-weighted MR images showed a bright hyperintense rim around a small eccentric flow void in the right vertebral artery (VA), which extended along all segments.Contrast-enhanced MR-angiography of the supra-aortic arteries performed afterwards showed an irregular stenosis of the right VA.There were no intracranial aneurysms.

The typical manifestation of vertebral artery dissection (VAD) is posterior headache or neck pain followed by posterior circulation transient ischaemic attack or stroke. Less frequent features include isolated neck pain, cervical spinal cord ischaemia, or radicular symptoms. Asymptomatic VADs have also been reported. The most dreaded and often lethal complication from intracranial extension of VAD is subarachnoid haemorrhage.

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9 comments

  1. Anonymous Says:
  2. stenosis of vertebral artery

     
  3. Anonymous Says:
  4. dissection of vertebral a.

     
  5. Anonymous Says:
  6. Dissection of vertebral artery

     
  7. Anonymous Says:
  8. Why dissection and not stenosis? Just because it's post-traumatic?

     
  9. Nimo Says:
  10. stenosis oth the a.vertebralis doue to slipped/herniated disk at C2 as seen on the transverse T1 MRI.
    Why dissection? She lived through the holiday to see a doctor. Symptoms are not as severe due to compensation at the Willis circle.

     
  11. DocDeb Says:
  12. I agree...stenosis due to herniated disc.

     
  13. JANAMAXIM Says:
  14. Vertebral Artery Stenosis...

     
  15. JANAMAXIM Says:
  16. Vertebral Artery Stenosis...

     
  17. JANAMAXIM Says:
  18. Due to trauma and pressure between vertebrae, possible herniated nucleus pulposus...

     

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