Vertebral artery dissection

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	Vertebral artery dissection;
	Arteries of the neck
ICD-9	443.24

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Vertebral artery dissection is the development of dissection (a flap-like tear) in the vertebral artery. It is commonly associated with physical trauma but may also develop spontaneously. It is a major cause of stroke in young people.

Presentation

Typical features are pain in the neck associated with stroke-like symptoms of the "posterior circulation": cranial nerve palsies, ataxia, and cortical visual loss.^[1] It can also cause subarachnoid hemorrhage (bleeding into the area around the brain); dissecting aneurysms of the vertebral artery represent about 4% of all aneurysms.^[2]

Incidence

The annual incidence is about 1 per 100,000 in America and 1.5 per 100,000 in France.^[2]

Diagnosis

Diagnostic Guidelines

==Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Recommendations for Vascular Imaging in Patients with Vertebral Arterial Disease^[3] (DO NOT EDIT)

(DO NOT EDIT)====

Class I
"1. Noninvasive imaging by CTA or MRA for detection of vertebral artery disease should be part of the initial evaluation of patients with neurological symptoms referable to the posterior circulation and those with subclavian steal syndrome. (Level of Evidence: C) "
"2. Patients with asymptomatic bilateral carotid occlusions or unilateral carotid artery occlusion and incomplete circle of Willis should undergo noninvasive imaging for detection of vertebral artery obstructive disease. (Level of Evidence: C) "
"3. In patients whose symptoms suggest posterior cerebral or cerebellar ischemia, MRA or CTA is recommended rather than ultrasound imaging for evaluation of the vertebral arteries. (Level of Evidence: C) "