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Images in Neurology
February 2010

A Very Small but Very Symptomatic Vertebral Artery Dissection

Author Affiliations

Author Affiliations: Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Dr Goddeau); and Departments of Neurology (Drs Caplan and Searls) and Radiology (Drs Hackney and Alhazzani), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Arch Neurol. 2010;67(2):248-249. doi:10.1001/archneurol.2009.318

A 45-year-old man developed sudden vertigo while riding a snowmobile. He attributed his symptoms to a cold, stayed home from work, and did not seek medical care. During the next 3 weeks, he had additional symptoms, including horizontal diplopia, dysarthria, and left arm clumsiness. When he developed left face and arm paresthesias, he came to the emergency department. Neuroimaging revealed chronic left proximal cerebellar and acute bilateral distal cerebellar infarctions (Figure 1), raising suspicion for embolism from the left vertebral artery.1,2 A cardiac source for embolism was not found. A curved reconstruction image from computed tomographic angiography of the neck showed a possible dissection flap in the V3 segment of the left vertebral artery (Figure 2A) that was most apparent on 1.25-mm axial source images (Figure 2B). Anticoagulation was started. On repeated computed tomographic angiography 1 month later, the dissection flap was resolving, but a pseudoaneurysm was apparent (Figure 2C). He had no further cerebrovascular events.

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