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ksmith

artery dissection

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This is kinda hard to read but I, along with a few ones here, have about 90% of the 'rare'

 

Vertebral Artery Dissection

Updated: Jan 18, 2017

Author: Eddy S Lang, MDCM, CCFP(EM), CSPQ; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...

 

Vertebral Artery Dissection

 

 

 

 

 

Vertebral artery dissection (VAD) is a relatively rare but increasingly recognized cause of stroke in patients younger than 45 years. Although the term spontaneous VAD is used to describe cases that do not involve significant blunt or penetrating trauma as a precipitating factor, many patients with so-called spontaneous VAD have a history of trivial or minor injury involving some degree of cervical distortion. 

 

 

 

 

Signs and symptoms

 

 

The typical patient with VAD is a young person who experiences severe occipital headache and posterior nuchal pain following a head or neck injury and subsequently develops focal neurologic signs attributable to ischemia of the brainstem or cerebellum. The focal signs may not appear until after a latent period lasting as long as 3 days, however, and delays of weeks and years also have been reported. Many patients present only at the onset of neurologic symptoms.

 

 

When neurologic dysfunction does occur, patients most commonly report symptoms attributable to lateral medullary dysfunction (ie, Wallenberg syndrome).

 

 

 

 

 

Patient history may include the following:

A, Dissection of the left vertebral artery secondary to guidewire injury. B, Complete resolution occurred in 6 months with only aspirin and clopidogrel (Plavix) therapy.

 

 

 

~Ipsilateral facial dysesthesia (pain and numbness)  - Most common symptom

 

~Dysarthria or hoarseness (cranial nerves [CN] IX and X)

 

~Contralateral loss of pain and temperature sensation in the trunk and limbs

 

~Ipsilateral loss of taste (nucleus and tractus solitaries)

~Hiccups

~Vertigo

~Nausea and vomiting

~Diplopia or oscillopsia (image movement experienced with head motion)

~Dysphagia (CN IX and X)

~Disequilibrium

~Unilateral hearing loss 

 

Rarely, patients may manifest the following symptoms of a medial medullary syndrome:

Contralateral weakness or paralysis (pyramidal tract)

Contralateral numbness (medial lemniscus)

Depending upon which areas of the brainstem or cerebellum are experiencing ischemia, the following signs may be present:

Limb or truncal ataxia

Nystagmus 

Ipsilateral Horner syndrome 

Ipsilateral hypogeusia or ageusia (ie, diminished or absent sense of taste)

Ipsilateral impairment of fine touch and proprioception

Contralateral impairment of pain and thermal sensation in the extremities (ie, spinothalamic tract)

Lateral medullary syndrome 

 

 

 

Cerebellar findings may include the following:

 

 

*Nystagmus

*Medial medullary syndrome

*Tongue deviation to the side of the lesion (impairment of CN XII)

*Contralateral hemiparesis

*Ipsilateral impairment of fine touch and proprioception (nucleus gracilis)

*Internuclear ophthalmoplegia (lesion of the medial longitudinal fasciculus)

 

Diagnosis

Imaging studies in patients with suspected VAD may include the following:

Computed tomography (CT) scanning – Identifies subarachnoid hemorrhage ; CT angiography (CTA), along with magnetic resonance angiography (MRA), are the imaging modalities of choice for vertebral artery dissections; however, CTA is less accurate in the presence of calcified arteries.

Magnetic resonance imaging  – Detects both the intramural thrombus and intimal flap that are characteristic of VAD [7] ; hyperintensity of the vessel wall seen on T1-weighted axial images is considered by some to be pathognomonic of VAD

MRA – Can identify a pseudolumen and aneurysmal dilation of the artery

Four-vessel cerebral angiography [7]  – Once the criterion standard for diagnosis, now largely supplanted by noninvasive techniques

Vascular duplex scanning – Demonstrates abnormal flow in 95% of patients with VAD, [8] but shows signs specific to VAD (eg, segmental dilation of the vessel, eccentric channel) in only 20%

Transcranial Doppler ultrasonography – Approximately 75% sensitive to the flow abnormalities seen in VAD useful also in detecting high-intensity signals (HITS), which are characteristic of microemboli propagating distally as a result of the dissection; ultrasonography may have a role in the initial diagnosis of dissections if CT-A or MRA are unavailable.

Because VAD occurs in young, generally healthy individuals, laboratory evaluation is directed toward establishing baseline parameters in anticipation of anticoagulant therapy, as follows:

 

Prothrombin time (PT) with international normalized ratio (INR)

Activated partial thromboplastin time (aPTT)

In addition, elevation of the erythrocyte sedimentation rate (ESR) may suggest vasculitis involving the cerebrovascular circulation.

 

 

Management

Acute management of proven or suspected spontaneous VAD is as follows 

Anticoagulants and antiplatelet agents are the drugs of choice to prevent thromboembolic disorders; the data suggest no difference between the two modalities on outcomes and adverse effects

More potent agents (eg, intra-arterial thrombolytics) have been used in selected cases; there may be a role for these medications during acute ischemic events


Endovascular and surgical treatments are reserved for patients with concomitant complications or whose maximal medical therapy is unsuccessful

 

 

http://emedicine.medscape.com/article/761451-overview   Mine was a bleed ,result of the dissection, and since I pinched my neck to 'stop the bleed' caused clots that went into my Basilar Artery... crap

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Hard to read and SCARY!!  :scared:

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I know this subject very well that I can recite the symptoms above verbatim.   Interestingly, I did not experience any issues with my lower cranial nerves (lateral medulla) which is the PICA territory but Nerve XIII was definitely impacted.   What makes vertebral dissection so deadly is that many people perish from suffocation as they cannot control tongue and throat.  In many car accidents or neck chiropractor neck adjustments, a vertebral dissection can occur.

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4 hours ago, 2Fight said:

I know this subject very well that I can recite the symptoms above verbatim.   Interestingly, I did not experience any issues with my lower cranial nerves (lateral medulla) which is the PICA territory but Nerve XIII was definitely impacted.   What makes vertebral dissection so deadly is that many people perish from suffocation as they cannot control tongue and throat.  In many car accidents or neck chiropractor neck adjustments, a vertebral dissection can occur.

 

When I first read this I was practically jumping up and down with excitement for "someone gets me" I also found this site helpful http://vestibular.org/understanding-vestibular-disorder/symptoms Many people and doctors tell you that vestibular issues are based in the ear, which is true, though it can also mirror the sane issues that come from the brainstem and cerebellum. 

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Exactly.  I was diagnosed with brainstem vertigo and Central Vestibulopathy. It involves the vestibular nuclei and vestibulo-cerebellar disorder.  Areas involved include oculomotor vermis, fastigal nucleus, nodulus/uvala, flocculus/parafloculus which are areas of the cerebellum.

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Very interesting read. Except big words are the bane of my life!

 

I have dysarthria. I said to my neurologist the other day...WHY is the damn word so ridiculously hard to say???

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Oh I understand big words.... I always have something with me at all times to look up words.. or to spell them :) 

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