Table 2.
Vertebral Artery Dissections
| Sex/Age, y | Suspected or Confirmeda | Imaging Type | Repeat Imaging | Time to Imaging, d | Acute Treatment | Pertinent Imaging Findings |
|---|---|---|---|---|---|---|
| M/4.9 | Confirmed (definitions 1 and 2) | MRI and MRA | Angiography | 0 | Aspirin | PCA occlusion with traumatic damage to vertebral arteries of the upper cervical spine level |
| M/5.0 | Confirmed (definition 3) | MRI and MRA | None | 0 | LMWH | Complete absence of flow in the left vertebral artery |
| M/6.9 | Confirmed (definition 3) | MRI and MRA | None | 2 | LMWH | Markedly decreased signal in the vertebral artery; T1 of the neck showing thrombus within the cervical portion of the right vertebral artery |
| M/12.9 | Suspected | MRI and MRA | CTA | 0 | Aspirin | Occluded basilar artery with patent vertebral arteries; bilateral PCAs filled via posterior communicating arteries |
| M/5.7 | Suspected | MRI and MRA | None | 0 | LMWH | Scattered areas of cerebral infarction of different chronicity in posterior circulation; questionable area of irregularity at the posterior-medial aspect of the left vertebral artery’s origin |
| M/8.3 | Suspected | MRI and MRA | None | 5 | LMWH | Multifocal infarcts within the brain parenchyma; absent flow in the PCA |
| F/8.3 | Suspected | MRI and MRA | None | 5 | LMWH | Focus of cystic encephalomalacia at the mesencephalic-pontine junction; absent posterior communicating artery |
| M/4.4b | Confirmed (definitions 1 and 3) | MRI and MRA | Angiography | 23 | LMWH | Multiple infarcts in temporal lobe and bilateral thalami; repeat catheter angiography showed dissection with near occlusion of the cervical left vertebral artery |
| M/4.1 | Suspected | MRI and MRA | None | 2 | LMWH | Multiple infarcts in the cerebellar hemispheres with history of prior trauma |
| M/2.0 | Confirmed (definition 1) | MRI and MRA | None | 1 | Aspirin | Irregularity of the lumen of the left vertebral artery at the level of C2 |
| F/13.6 | Suspected | MRI and MRA | None | 2 | Aspirin | Multiple areas of infarction seen as restricted diffusion involving the inferior cerebellar hemisphere cortex and dorsal medulla |
| M/7.4b | Confirmed (definition 3) | MRI and MRA | Angiography | 1 | LMWH | Multiple areas of infarction in the cerebellar hemisphere, thalamus, and para median occipital and parietal lobes; filling defect in the left vertebral artery at the level of C2–C3 consistent with a nonocclusive thrombus |
| M/6.9 | Confirmed (definition 3) | MRI and MRA | None | 1 | None | Multiple areas of infarction in the cerebellum, thalamus, and parietal lobe; high-grade stenosis of the vertebral artery consistent with prior dissection |
| M/17.0b | Confirmed (definition 3) | CTA | Angiography | 0 | Aspirinc | Basilar artery thrombosis; received intra-arterial thrombolysis with mechanical thrombectomy |
| M/5.5b | Confirmed (definition 3) | MRI and MRA | Angiography | 0 | LMWH | Multiple infarcts in the lateral thalamus and occipital lobe; low-flow signal in the P1 segment of the PCA; repeat angiography showed a diminutive vertebral artery that appeared narrow throughout its length; portions were not discretely visualized |
| M/11.5 | Suspected | MRI and MRA | None | 27 | Aspirin | Brain MRI showing multiple small areas of hyperintensity and restricted diffusion involving the temporal lobe and thalamus |
| M/15.4 | Suspected | MRI and MRA | None | 1 | LMWH | Infarcts in the thalamus with history of recent trauma; hypoplastic vertebral artery |
| M/5.3b | Suspected | MRI and MRA | Angiography | 0 | LMWH | Multiple infarcts involving the cerebellar hemispheres, brachium pontis, and occipital lobe; angiography results consistent with basilar tip thrombus and stenosis involving the ostia of the SCAs bilaterally with distal thrombus identified |
| M/0.7 | Confirmed (definition 3) | MRI and MRA | CTA | 1 | Aspirin | Multiple infarcts of the bilateral cerebellar hemispheres and occipital lobe; subacute infarcts of the medial temporal lobes and thalamus; vertebral artery occlusion |
Abbreviations: CTA, computed tomography angiography; LMWH, low-molecular-weight heparin; MRA, magnetic resonance angiography; MRI, magnetic resonance imaging; PCA, posterior cerebral artery; SCA, superior cerebellar artery.
a
Definition 1 = angiographic findings of a double lumen, intimal flap, or pseudo aneurysm, or, on axial T1 fat saturation MRI images, a “bright crescent sign” in the arterial wall; Definition 2 = the sequence of cervical or cranial trauma, or neck pain, or head pain less than 6 weeks preceding angiographic findings of segmental arterial stenosis (or occlusion) located in the cervical arteries; Definition 3 = angiographic segmental stenosis (or occlusion) of the vertebral artery at the level of the C2 vertebral body, even without known traumatic history.
b
Recurrence.
c
Following intra-arterial thrombolysis with mechanical thrombectomy.