Zhang HB, Duan YH, Zhou M, Liang RC. High-resolution magnetic resonance imaging in the diagnosis and management of vertebral artery dissection: A case report. World J Radiol 2024; 16(10): 593-599 [PMID: 39494136 DOI: 10.4329/wjr.v16.i10.593]
Corresponding Author of This Article
Min Zhou, PhD, Assistant Professor, Department of Neurosurgery, The Second Affiliated Hospital of University of South China, No. 35 Jiefang Avenue, Hengyang 421001, Hunan Province, China. 2015020049@usc.edu.cn
Research Domain of This Article
Health Care Sciences & Services
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Oct 28, 2024; 16(10): 593-599 Published online Oct 28, 2024. doi: 10.4329/wjr.v16.i10.593
High-resolution magnetic resonance imaging in the diagnosis and management of vertebral artery dissection: A case report
Hai-Bin Zhang, Yong-Hong Duan, Min Zhou, Ri-Chu Liang
Hai-Bin Zhang, Department of Neurosurgery, The Leiyang City People's Hospital, Hengyang 421001, Hunan Province, China
Yong-Hong Duan, Min Zhou, Ri-Chu Liang, Department of Neurosurgery, The Second Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
Co-first authors: Hai-Bin Zhang and Yong-Hong Duan.
Co-corresponding authors: Min Zhou and Ri-Chu Liang.
Author contributions: Zhang HB and Zhou M wrote and revised the manuscript; Liang RC and Duan YH guided the treatment and follow-up of the case throughout the whole process; all authors have read and approved the final manuscript.
Supported byThe Clinical Innovation Guidance Program of Hunan Provincial Science and Technology Department, China, No. 2021SK51714; and The Hunan Nature Science Foundation, China, No. 2023JJ30531.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Zhou, PhD, Assistant Professor, Department of Neurosurgery, The Second Affiliated Hospital of University of South China, No. 35 Jiefang Avenue, Hengyang 421001, Hunan Province, China. 2015020049@usc.edu.cn
Received: May 23, 2024 Revised: August 29, 2024 Accepted: September 6, 2024 Published online: October 28, 2024 Processing time: 157 Days and 23.5 Hours
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
HR-MRI can provide precise evidence for the identification of VAD.
Core Tip: In a young male patient with headache, aphasia and dysfunction after an argument, emergency head computed tomography indicated subarachnoid hemorrhage, head magnetic resonance imaging (MRI) indicated bilateral cerebellar hemispheres and brainstem infarction, digital subtraction angiography indicated bilateral vertebral artery stenosis, but no obvious dissection was found. Finally, high-resolution MRI (HRMRI) revealed clear vertebral artery dissection (VAD). Although the patient's clinical history and initial imaging findings suggested VAD, definitive diagnosis was only achievable through HRMRI, underscoring its critical role in accurately diagnosing VAD.
