Pregnancy and postpartum are phases in the women's life where the thrombotic risk is increased both on the venous and on the arterial side.

We are presenting the case of a young woman at the third pregnancy, carried out without complications until delivery, whose postpartum was characterized by the occurrence of headache. Neuroimaging studies were performed, firstly brain computed tomography (CT) with CT Angiography and after brain Magnetic Resonance Imaging (MRI) with MR Angiography. The main finding was the simultaneous presence of two cerebrovascular vascular diseases, i.e. cerebral venous thrombosis (CVT) and left carotid dissection, without stroke. The neuroimaging features of both the diseases were analyzed and both CVT and dissection had neuroimaging markers of acute timing. After starting heparin therapy at anticoagulant dose the clinical symptoms disappeared within a few days.

CVT is a rare event with a peak in the late pregnancy and puerperium, but other arterial cerebrovascular events, as spontaneous dissection, have not an increased incidence in the postpartum. Headache is one of the main symptoms for all these cerebrovascular diseases, but usually stroke is the accompanying event. This is not always true and the presented case illustrates this unexpected occurrence.

Headache is a nonspecific and highly prevalent symptom and in the postpartum period it could raise the suspicion of CVT. Sometimes several different causes are found for the same symptom and concurrent acute cerebrovascular diseases might be considered. Neuroimaging investigations may help for diagnosis and timing concurrent thrombotic diseases, particularly DWI-MRI.

An unusual case of a patient with bilateral carotid artery dissection caused by compression from elongated styloid processes is presented. The diagnosis was overlooked 8 years earlier. Eagle syndrome, marked by an elongated styloid process, can result in cervical artery dissection, highlighting the significance of recognizing this correlation in recurrent cases, which occur more frequently than idiopathic internal carotid artery dissections.

Syncope, a brief loss of consciousness, has many potential causes, with internal carotid artery (ICA) stenosis being a relatively uncommon but serious one. We present the case of a 62-year-old man from Dhaka, Bangladesh, who experienced recurrent syncope over 6 months, characterized by a brief loss of consciousness, occasional dizziness, and blurred vision. Despite a history of hypertension and hyperlipidemia, initial cardiac and neurogenic investigations were inconclusive. Magnetic resonance angiography revealed 90% stenosis of the right ICA, which was confirmed by digital subtraction angiography. The patient was treated with antiplatelet therapy, statins, and antihypertensives, and underwent carotid artery stenting. His postoperative recovery was uneventful, and he remained symptom-free during follow-up. This case underscores the importance of considering ICA stenosis in patients with recurrent syncope and comorbid vascular disease, particularly in resource-limited settings where timely diagnosis and intervention can prevent serious cerebrovascular complications.

Retrospective review of a single institution cohort.

To assess the injury characteristics and outcomes in patients who suffered trauma to the cervical spine and vertebral artery injury (VAI).

This was a retrospective study of patients admitted to our trauma center with osseous or ligamentous cervical spine injury and VAI. Imaging findings were reviewed to classify the fracture types and fracture extension into transverse foramina was noted. Electronic medical records were reviewed to capture the mechanism of injury, discharge disposition, neurologic status, and mortality. Kaplan-Meier analysis was performed to determine the mean survival time and cumulative survival rate.

Ultimately, 30 patients were included for the analysis. The mean age was 56 years old (range: 18-91 years). There were four major subgroups of cervical injuries: unilateral facet fractures (9 patients, 30%), occipital-cervical junction fractures (15 patients, 50%), translation or distraction injuries (3 patients, 10%), and injuries without extension into transverse foramina (20 patients, 67%). Left-sided VAIs were more common than right-sided (60% vs. 37%). Twelve patients (40%) initially presented with neurological symptoms. Nine patients (30%) died by final follow-up; the mean survival time for the cohort was 704.5 days (95% confidence interval: 440.1-968.9 days).

The laterality of facet fractures and fractures extending into the transverse foramina are associated with VAI sidedness. Various mechanisms may account for injury presentation, including rotation and hyperflexion. Given that patients may initially present without neurologic deficits, it is recommended that cervical trauma protocols integrate computed tomography angiography to reduce morbidity and mortality.

Ruptured vertebral artery dissections frequently exhibit pearl-and-string signs, a characteristic also observed in many unruptured dissections. This study examines the natural course of 50 unruptured acute vertebral artery dissections presenting with pearl-and-string signs and compares them to 10 ruptured dissections of the same morphological pattern.

We reviewed 633 radiology reports of head and neck imaging studies that included the keyword 'dissection'. From these, 60 cases displaying pearl-and-string signs were identified from a total of 322 vertebral artery dissections. These cases were classified based on morphological characteristics, including fusiform versus bulbous dilatation, symmetry, degree of expansion, and the severity of stenosis at both ends of the dilation. The relationships between these factors and favorable anatomical recovery were then analyzed.

Headaches were linked to subarachnoid hemorrhages in 10 cases with bulbous dilatations. In contrast, 50 unruptured cases had fusiform dilatations, with no subsequent hemorrhages except for two cases treated preventively. Most unruptured dissections (78.4%) improved on follow-up: 48.6% fully recovered, 29.7% retained smooth dilatation, 10.8% developed irregular stenotic segments, 8.1% became occluded, and 2.7% transformed into a saccular lesion. Smaller or hypoplastic vertebral arteries were more likely to occlude (p = 0.017). Mild distal stenosis was associated with improvement (p = 0.001).

Acute unruptured intracranial vertebral artery dissections with 'pearl-and-string' signs had benign courses, with most recovering spontaneously and no subsequent hemorrhages. Regular imaging follow-ups at one- to three-month intervals are recommended over immediate intervention.

Vertebral artery dissection (VAD) is a rare but life-threatening condition characterized by tearing of the intimal layer of the vertebral artery, leading to stenosis, occlusion or rupture. The clinical presentation of VAD can be heterogeneous, with common symptoms including headache, dizziness and balance problems. Timely diagnosis and treatment are crucial for favorable outcomes; however, VAD is often missed due to its variable clinical presentation and lack of robust diagnostic guidelines. High-resolution magnetic resonance imaging (HRMRI) has emerged as a reliable diagnostic tool for VAD, providing detailed visualization of vessel wall abnormalities.

A young male patient presented with an acute onset of severe headache, vomiting, and seizures, followed by altered consciousness. Imaging studies revealed bilateral VAD, basilar artery thrombosis, multiple brainstem and cerebellar infarcts, and subarachnoid hemorrhage. Digital subtraction angiography (DSA) revealed vertebral artery stenosis but failed to detect the dissection, potentially because intramural thrombosis obscured the VAD. In contrast, HRMRI confirmed the diagnosis by revealing specific signs of dissection. The patient was managed conservatively with antiplatelet therapy and other supportive measures, such as blood pressure control and pain management. After 5 mo of rehabilitation, the patient showed significant improvement in swallowing and limb strength.

HR-MRI can provide precise evidence for the identification of VAD.