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 VAD-JN

NP,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 foram

en to the dura, most of the spo

ntaneous dissected region.

• Can extended to segment IV(u

pstream) with neurological s/s.

• Most injured rotated point.

Segment I: Rises from the

Subclavian artery to the trans

verse 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%

V2 =35%

V3 =34%

V4= 11%

(Stroke, 2006)

Younger age+

Low NIHSS score

=> are good

prognostic outcome

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.