Vertibral Dissection: Stroke-Free Possibility Explained

Vertebral artery dissection (VAD) is a rare cause of stroke, but it is one of the more common causes of stroke in patients under 45 years of age. It is often the result of neck distortion caused by chiropractic manipulation, bending of the neck, or blunt trauma. However, in some cases, VAD can occur without any preceding trauma or other apparent cause. While the dissection of the artery may ultimately lead to a stroke, this is not always the case, and some people may have a vertebral dissection without experiencing a stroke. The treatment for VAD focuses on preventing stroke through the use of antiplatelet or anticoagulant medications, and in some cases, endovascular or surgical procedures may be necessary.

Vertebral artery dissection (VAD) is a rare cause of stroke, but one of the more common causes in patients under 45

Vertebral artery dissection (VAD) is a rare cause of stroke, accounting for only 2% of ischemic strokes. However, it is one of the more common causes of stroke in patients under 45, with up to 25% of strokes in this age group being a result of VAD. The vertebral artery supplies the brain and spine with oxygen-rich blood and is comprised of three layers: the intima, the media, and the adventitia. A dissection occurs when there is a tear in one or more of these layers, which can be caused by a minor injury or trauma to the neck. Symptoms of VAD include severe occipital headache, neck pain, and focal neurologic signs such as lateral medullary dysfunction (Wallenberg syndrome). Diagnosis can be difficult due to vague symptoms and the need for advanced imaging techniques such as magnetic resonance angiography (MRA) and computed tomography (CT) scans. Treatment typically involves blood-thinning medications such as aspirin or heparin to prevent blood clots and reduce the risk of stroke. In some cases, endovascular or surgical procedures may be necessary. The prognosis for VAD is generally good, with most patients making a full recovery, although there is a risk of future dissections.

VAD can be caused by neck distortion, such as chiropractic manipulation, bending of the neck, or blunt trauma

Vertebral Artery Dissection (VAD) is a rare cause of stroke in the general population, but it is one of the more common causes of stroke in patients younger than 45. The signs and symptoms of VAD can be vague, making diagnosis difficult. While spontaneous dissections have been reported, incidental minor trauma often precipitates this potentially dangerous condition.

VAD can be caused by neck distortion, such as:

• Chiropractic manipulation
• Bending of the neck
• Blunt trauma

Chiropractic manipulation of the neck has been linked to VAD, with one source stating that approximately 1 in 20,000 spinal manipulations result in a vertebral artery aneurysm/dissection and ischemic infarct. However, it is important to note that there is no conclusive evidence linking the two, and the exact incidence of this complication is unknown.

Bending of the neck can also cause VAD. This can occur during activities such as painting the ceiling, or as a result of whiplash-type injuries from motor vehicle collisions or contact sports.

Blunt trauma to the neck is the most commonly reported precipitating event for VAD. This can include road traffic collisions, assaults, and sports-related injuries. The elderly are particularly vulnerable to blunt trauma to the neck due to falls.

Symptoms of VAD include severe occipital headache, posterior nuchal pain, and focal neurological signs

Vertebral Artery Dissection (VAD) is a rare cause of stroke, but it is one of the more common causes of stroke in patients younger than 45 years of age. The signs and symptoms of VAD can be vague, making diagnosis difficult. However, symptoms of VAD include severe occipital headache, posterior nuchal pain, and focal neurological signs.

The typical patient with VAD is a young person who experiences severe occipital headache and posterior nuchal pain following a head or neck injury. The occipital headache is often described as a sharp, jabbing, electric shock in the back of the head and neck. The pain typically starts at the base of the head and spreads upwards to one or both sides of the head. It may also be felt behind one eye. Even simple movements, such as combing hair or lying on a pillow, can trigger these symptoms.

In addition to the occipital headache, patients with VAD may also experience posterior nuchal pain, which is severe unilateral neck pain in the occipital-cervical area of the neck or head. This pain is typically acute and severe, and it may be preceded by minor neck trauma.

Focal neurological signs may not appear until a few days after the onset of symptoms, but delays of weeks or even years have also been reported. When neurological dysfunction does occur, patients most commonly report symptoms attributable to lateral medullary dysfunction, also known as Wallenberg Syndrome. This includes symptoms such as facial dysesthesia, dysarthria, dysphagia, diplopia, and unilateral hearing loss.

The vague and varied nature of VAD symptoms, as well as their similarity to other conditions like migraines, can make diagnosis challenging. However, prompt diagnosis and treatment are crucial as VAD can lead to stroke and other serious complications.

VAD can be diagnosed using imaging studies such as CT scanning, MRI, and MRA

Vertebral Artery Dissection (VAD) is a rare cause of stroke in the general population, but it is one of the more common causes of stroke in patients younger than 45. The signs and symptoms of VAD can be vague, and diagnosis can be elusive. However, imaging studies such as CT scanning, MRI, and MRA can be used to diagnose VAD.

Magnetic Resonance Angiography (MRA) is a type of MRI that specifically examines the body's blood vessels. It is a less invasive and less painful test than a traditional angiogram, which requires inserting a catheter into the body. During an MRA, the patient lies flat inside an MRI scanner—a large, tunnel-like tube. A special dye may be added to the bloodstream to make the blood vessels more visible.

MRA is often used when a healthcare provider suspects a narrowing or blockage of blood vessels or other conditions such as an aneurysm, aortic coarctation, aortic dissection, or renal artery stenosis. While MRA is a valuable tool, there are some risks and considerations. For example, patients with metal implants or metal objects in their pockets or clothing may not be suitable candidates for MRA.

Computed Tomography (CT) scanning and CTA (computed tomography angiography) are also valuable tools in diagnosing VAD. A CT scan can demonstrate posterior fossa ischemia or subarachnoid hemorrhage and identify an occluded vertebral artery or mural thrombus. CTA is superior to CT scanning in detecting irregularities in the vascular lumen or thickening of the arterial wall.

MRI is another imaging technique that can be used to diagnose VAD. It can detect an intimal flap and luminal thrombosis and visualize hyperintensity of the vessel wall on T1-weighted images. MRI is a highly effective method for establishing a diagnosis, but it may not be readily available to all patients.

Treatment for VAD includes anticoagulants and antiplatelet agents to prevent thromboembolic disorders

Treatment for vertebral artery dissection (VAD) includes anticoagulants and antiplatelet agents to prevent thromboembolic disorders.

Anticoagulants are drugs that prevent blood from clotting. They are used to prevent recurrent or ongoing thromboembolic occlusion of the vertebrobasilar circulation. Heparin is the most commonly used anticoagulant in the treatment of VAD.

Antiplatelet agents are drugs that decrease platelet aggregation and inhibit thrombus formation. Aspirin is the most commonly used antiplatelet agent in the treatment of VAD.

Frequently asked questions