|
| Case # | Age/sex | Risk factor | Trigger | Clinical presentation | Vessel | Imaging | Medical management | Surgical management | Outcome | Comments |
|
| (1) Katirji et.al. [7] | (1) 26 F
(2) 34 M | (a) None
(b) None | (a) Fall plus chiropractic manipulation; (b) none | (1) Neck pain, headache, vertigo, nausea, and vomiting
(2) Occipital headache, subsequent locked-in syndrome | (1) Angio: bilateral VA dissection at C1–C6
(2) Autopsy: RVA and LVA thrombosis | (1) CT: right cerebellar aneurysm.
(2) CT: bilateral cerebellar and pontine infarct | (1) Heparin, dexamethasone, human plasma protein fraction, and warfarin
(2) None | None | (1) Residual right-sided ataxia
(2) Patient died after 2 weeks | Collected from a 5-case report |
| (2) Leys et al. [8] | 35 M | None | None | Vertigo, diplopia, right limb weakness, and occipital pain | Angio: RVA with double lumen and irregular stenosis of LVA | CT scan: unremarkable | Heparin for 2 months and then aspirin 500 mg | None | At 1 year: persistent left miosis and right hypoesthesia to temperature and pain | — |
| (3) Rae-Grant et al. [9] | 31 M | None | MVA | Occipital headache, nausea, and progression to locked-in syndrome | Angio: RVA occlusion at C1, C2; LVA unperfused beyond PICA | MR: pontine SAH, right cerebellar infarct | Supportive care | None | Extraocular impairment and paresis of four extremities | — |
| (4) Philips et al. [10] | 39 M | None | 10 days course of chiropractic manipulation for neck pain | Dizziness, speech disturbance, and left-sided weakness than progressed to pure motor deficit of the left side | Angio: LVA occlusion at C6. RVA irregular stenosis through foramen transversarium | CT: right-sided midpontine infarct | None; patient transferred to final facility 4 days after stroke when symptoms were improving | None | Partial motor improvement; dependent on cane and drop-foot splint | — |
| (5) Fox and Lavin. [11] | 30 M | None | MVA | Occipital headache, vertigo, and progression to locked-in syndrome | Angio: absence of flow above C1in both vertebral arteries | MR: pontine infarct, right cerebellar infarct with SAH | Heparin | None | Speech impairment and ambulation with assistance | — |
| (6) Hinse et al. [12] | (1) 39 F
(2) 28 F | 1. None
2. Chronic hypertension | (a) MVA
(b) None | (1) Right neck pain, vertigo, dysarthria, right Horner, and left hemiparesis
(2) Vertigo, unsteady gait | (1) DSA: RVA stenosis at C1-C2, irregularities in LVA
(2) DSA: RVA stenosis at C1-C2; LVA occlusion at C1 | (2) CT: left PICA/cerebellar infarct | (1) Heparin and phenprocoumon
(2) Heparin and coumarin | None | (1) Hemisensory deficit
(2) No neurologic deficits | Collected from a 4-case report |
| (7) el Nakadi. et al. [13] | 35 F | DM | None | Several transient episodes of headache, nausea, ataxia, and sensory loss | DSA: RVA stenosis with double lumen. LVA occlusion at C1 | MR: left occipital and right cerebellar lobe infarcts | Antiaggregation therapy: not specified | None | Fluctuant ischemic symptoms with persistent occlusion of RVA after 1 year. | — |
| (8) Chang et al. [14] | 29 M | None | None | Headache, left facial and perioral numbness, tingling of the right upper extremity, vertigo, ataxia, hoarseness, and dysphagia | Angio: RVA stenosis at C1-C2, LVS stenosis at the foramen magnum | MR: PICA infarct | Heparin, warfarin | None | Speech impairment | — |
| (9) Garnier et al. [15] | 45 F | None | None | Atypical, right cervical Brown-Sequard’s syndrome | Angio: bilateral vertebral artery dissection | Angio: irregular stenosis of the right and left cervical vertebral artery | Anticoagulation: not specified | None | 1 yr follow-up: spastic paraparesis with right-sided central pain and mild urinary retention; MRI and MRA showed the resolution | No specification of anticoagulation drug of choice |
| (10) Karnik et al. [16] | 49 F | None | Inline skating without microtrauma | Left side neck pain | MR angio: LVA dissection. MR angio 4 weeks later: RVA dissection | MR 4 weeks after: bilateral medullary infarcts | Heparin | None | At 6 months follow-up: no neurologic deficits | — |
| (11) Medhkour and Chan [17] | 52 F | None | MVA | GCS score 14 (confused) | Angio: RVA pseudoaneurysm and occlusion at C5. LVA occlusion at C5 | CT and MR: unremarkable | Heparin | None | Currently without neurologic deficits | — |
| (12) Taylor. and Senkowski. [18] | 46 M | None | MVA | GSC score 3 | Angio: bilateral VA disruption with no posterior collateral circulation | CT: basilar cistern edema | Supportive care | None | Patient died after withdrawal of ventilation | — |
| (13) Nagdir et al. [19] | 34 M | None | Chiropractor neck manipulation | Left side loss of coordination and involuntary movements, dysarthria, and hypoesthesia | MR angio: bilateral internal carotid dissection, LVA dissection, and RVA pseudoaneurysm at C1/C2 | MR: multiple thalamic infarcts | Heparin | None | Partial resolution of symptoms with left-sided hemianesthesia | — |
| (14) Nagurney et al. [20] | 23 F | Migraines | Strenuous exercise sessions | Several episodes of self-resolving occipital pain associated with visual disturbances: blurry vision, scintillations, and transient visual field loss | CT angio: bilateral vertebral artery dissection | MR brain: unremarkable | Heparin for 10 days; oral anticoagulation with warfarin for 6 months | None | Follow-up at 6 months: images showed complete resolution | — |
| (15) Hagiwara et al. [21] | 48 M | None | Sleeping in a bad position | Severe occipital headache for 7 days and high blood pressure | MR angio: disappearance of signal flow with filling defects in the bilateral VA and BA | CT and MR unremarkable for ischemic or hemorrhagic changes | Anticoagulation: heparin bridge to warfarin | None | Not specified | — |
| (16) Schneck et al. [22] | 33 F | None | Roller coaster | Initial head and neck pain progressed to blurry vision and right monocular vision loss in 14 days | Angio: bilateral dissection of vertebral arteries | MR unremarkable for ischemic or hemorrhagic changes | Anticoagulation: Heparin bridge to warfarin for 6 months. | None | 6 months follow-up: patient was asymptomatic | Patient was changed to aspirin 325 mg after 6 months |
| (17) Chakrapani et al. [23] | 50 F | None | Face and neck massage | Initial head and neck pain; 13 d: sudden left side neck and retro-orbital pain; ptosis and miosis | MR angio: RVA narrowed from C3 to C5, LVA from C2 to C5, and bilateral ICAs hematomas | MR was unremarkable for ischemic or hemorrhagic changes in the brain | Anticoagulation: heparin bridge to warfarin plus clopidogrel plus aspirin | None | 6 months follow-up: patient was asymptomatic; 1 yr CT scan: right ICA residual dissection of 30%; left ICA dissection resolved; persistent 30 to 50% dissection of VA bilaterally | Patient stopped warfarin at 6 months; continued with clopidogrel for 18 months and aspirin indefinitely |
| (18) Preul et al. [24] | 33 F | None | Chiropractor maneuver | Acute onset headache after snapping sensation; generalized seizures; later on: nystagmus to the right and right-sided hemiataxia and Babinski’s sign | MR angio: bilateral; VA dissection with progression to the BA | MR revealed acute infarctions in the cerebellum and pons on the right and in the left thalamus and the posterior limb of the internal capsule | Anticoagulation with heparin bridge to warfarin | None | 3mo: walk independently; 3 yrs: symptom free | 6mo MRI: residual aneurysm of the left extracranial vertebral artery |
| (19) Ozkan arat et al. [25] | 35 F | None | Roller coaster ride | Right side neck pain, transient right monocular vision loss | Angio: bilateral internal carotid and vertebral artery dissection | Brain imaging studies not reported | Anticoagulation therapy: heparin bridge to warfarin for 3 months | None | At 3 months: stable; no strokes, no further neurologic deficit | — |
| (20) Shibata et al. [26] | 51 M | None | None | Sudden onset of occipital pain; progressive quadriplegia more pronounced in lower limbs and bilateral hearing loss and vertigo | CT angio: bilateral vertebral artery dissection | MR brain: unremarkable | Anticoagulation with heparin followed by oral antiplatelet therapy (aspirin) | None | 1 month follow-up: remaining gait disturbance | — |
| (21) Koleilat et al. [27] | 23 F | None | MVA | Left hemiparesis, dysarthria | CT angio: bilateral internal carotid and vertebral artery dissection | CT showed right caudate head and basal ganglia infarction | Anticoagulation with heparin and warfarin at discharge | None | Ambulates independently, residual left-sided weakness; maintained on aspirin 81 mg daily after completing 1 yr of warfarin therapy | Repeat CT of the head and neck at 32 months reveals persistent but nonocclusive dissection of bilateral carotid arteries |
| (22) Frankowska et al. [28] | 33 M | None | Squash game without direct trauma | Headache, nausea, vomit, and right homonymous hemianopsia | CT angio: bilateral vertebral and medial occipital artery occlusion; emergency angio after rt-PA: thrombi in the basilar artery and LVA | Perfusion CT: ischemic areas in the left occipital lobe | Rt-PA; heparin after CT control 24 hr; switch to warfarin for 6 months | Suction thrombectomy | At 12 months follow-up: patient stable with right marginal incomplete hemianopsia | — |
| (23) Richard et al. [29] | 30 M | Migraines | None | 4 months of headache resistant to treatment; furtive vertigo and 1 month of permanent paralysis of the right arm | US and CT angio: bilateral vertebral and bilateral ICAs dissection | MR brain: small bilateral cerebellar infarct; MR spine: right posterior cord cervical infarct | Anticoagulation with heparin, bridged to warfarin for 3 months | None | Follow-up at 3 months: partial resolution of symptoms; MR angio control: persitent LVA occlusion; RVA and ICAs stable | Anticoagulation therapy was replaced by aspirin 160 mg for 9 months |
| (24) Villella et al. [30] | 37 F | None | None | Sudden onset and persistent headache, nausea, and vertigo for 2 weeks despite pain medication | CT angio: bilateral vertebral artery dissection. | CT and MR: unremarkable | Anticoagulation, not specified | None | Not specified | — |
| (25) Goyal [31] | 28 F | None | 2 weeks postpartum | Right hemiparesis, gaze deviation, and mixed aphasia | DSA; bilateral internal carotid and vertebral artery dissection | CT: showed ischemic changes in the right parieto-occipital lobe | Bolus dose of heparin intravenously followed by a loading dose of clopidogrel (Plavix) | Three overlapping stents were deployed in the left ICA and 3 more in the right ICA | Poststenting angiography demonstrated successful reconstruction of the cervical ICAs; CT angiography at 6 months demonstrated complete patency of the stents and healing of the vertebral dissections | — |
| (26) Mas et al. [32] | 30 M | None | Basketball game | Severe dysphagia, right hemiparesis, and balance dysfunction | MR angio: bilateral vertebral artery dissection | MR: multiple cerebellar infarcts | Anticoagulation, not specified | Gastrostomy 2/2 severe dysphagia | Data not available | — |
| (27) Stirn et al. [33] | 28 F | Acute demyelinating encephalomyelitis | ADEM flare (proposed by the authors) | 2 weeks of bilateral nuchal pain, left side motor deficit (hemiparesis) | MR angio: bilateral intramural hematoma of the vertebral arteries | 1st MR brain (2 weeks before episode): ischemic lesion in the right parietal lobe without signs of vessel damage; 2nd MR brain: increased lesion in the same area | Anticoagulation not specified; 2 cycles of corticosteroids IV (5 days of 2gr) | None | Follow-up 11 months: resolution of symptoms, slow remission of the intracranial lesion | Autoimmune inflammation of vessels proposed as trigger for spontaneous bilateral VA dissection |
| (28) Ke et al. [34] | 36 M | None | Chiropractic manipulation | Neck pain, right side hemiplegia and hemiparesis, progression to locked-in syndrome | CTA: bilateral vertebral artery dissection | MR brain 17 d after the event: pontine ischemia | Antiplatelet therapy after embolectomy (drug of choice not specified) | Embolectomy | Discharge at day 27: partial resolution of symptoms; persistent left side weakness and hyper-reflexia | — |
| (29) Lovencric [35] | 40 F | Migraines, low BMI, and recent infection | None | Generalized weakness, neck pain, dizziness, and headache for 10 days plus transient visual disturbances | MR angio: bilateral vertebral artery dissection | CT and MR: bilateral ischemic lesions in the posterior circulation | Anticoagulation with LMWH and bridge to warfarin | None | Symptoms reverted 2 weeks after starting anticoagulation; no information on further follow-up | — |
| (30) Peters and Engelter [36] | 35 F | None | None | Neck pain, ataxia, and imbalance | MR angio: bilateral distal vertebral artery dissection | MR: bilateral cerebellar infarcts, larger on the right side | Warfarin for 12 months | None | At 12 months: asymptomatic | — |
|
