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Vertebral Artery Dissection
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Vertebral artery (VA) dissection
              • Definitions

                • Irregularity of VA contour from intimal tear or subadventitial hematoma

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Kidoh M et al: MR diagnosis of vertebral artery dissection: value of 3D time-of-flight and true fast imaging with steady-state precession fusion imaging. Insights Imaging. 4(1):135-42, 2013
                                            2. Ahn SS et al: Spontaneous symptomatic intracranial vertebrobasilar dissection: initial and follow-up imaging findings. Radiology. 264(1):196-202, 2012
                                            3. Burlew CC et al: Blunt cerebrovascular injuries: redefining screening criteria in the era of noninvasive diagnosis. J Trauma Acute Care Surg. 72(2):330-5; discussion 336-7, quiz 539, 2012
                                            4. Gottesman RF et al: Clinical characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist. 18(5):245-54, 2012
                                            5. Gottesman RF et al: Imaging characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist. 18(5):255-60, 2012
                                            6. Hongo H et al: Dermatomal Sensory Manifestations in Lateral Medullary Infarction. J Stroke Cerebrovasc Dis. 2012 Oct 22. doi:pii: S1052-3057(12)00320-5. 10.1016/j. jstrokecerebrovasdis. Epub ahead of print, 2012
                                            7. Haynes MJ et al: Assessing the risk of stroke from neck manipulation: a systematic review. Int J Clin Pract. 66(10):940-7, 2012
                                            8. Kennedy F et al: Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology. 79(7):686-9, 2012
                                            9. Matsukawa H et al: Differences in Vertebrobasilar Artery Morphology between Spontaneous Intradural Vertebral Artery Dissections with and without Subarachnoid Hemorrhage. Cerebrovasc Dis. 34(5-6):393-399, 2012
                                            10. Fusco MR et al: Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery. 68(2):517-30; discussion 530, 2011
                                            11. Fusco MR et al: Cerebrovascular dissections--a review part I: spontaneous dissections. Neurosurgery. 68(1):242-57; discussion 257, 2011
                                            12. Burlew CC et al: Blunt cerebrovascular trauma. Curr Opin Crit Care. Epub ahead of print, 2010
                                            13. Campbell-Lloyd AJ et al: Vertebral artery dissection after direct laryngoscopy: case report and literature review. J Laryngol Otol. 123(2):e11, 2009
                                            14. Kawakami Y et al: An 8-year-old boy with vertebral artery dissection with cerebellar ataxia featuring suspected vertebral artery hypoplasia. Brain Dev. 31(4):326-30, 2009
                                            15. Kesser BW et al: Contemporary management of penetrating neck trauma. Am Surg. 75(1):1-10, 2009
                                            16. Kocaeli H et al: Spontaneous intradural vertebral artery dissection: a single-center experience and review of the literature. Skull Base. 19(3):209-18, 2009
                                            17. Koh JS et al: Bilateral vertebral-artery-dissecting aneurysm causing subarachnoid hemorrhage cured by staged endovascular reconstruction after occlusion. Cerebrovasc Dis. 27(2):202-4, 2009
                                            18. Kulcsar Z et al: Vertebral artery dissection as an extremely rare cause of spinal epidural hematoma: case report and review of the literature. Acta Neurochir (Wien). 151(10):1319-23, 2009
                                            19. Lee CK et al: Traumatic vertebral artery injury: detailed clinicopathologic and morphometric analysis of 6 cases. Am J Forensic Med Pathol. 30(2):134-6, 2009
                                            20. Lum C et al: Vertebral artery dissection with a normal-appearing lumen at multisection CT angiography: the importance of identifying wall hematoma. AJNR Am J Neuroradiol. 30(4):787-92, 2009
                                            21. Park SI et al: Clinical and angiographic follow-up of stent-only therapy for acute intracranial vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol. 30(7):1351-6, 2009
                                            22. Provenzale JM et al: Comparison of test performance characteristics of MRI, MR angiography, and CT angiography in the diagnosis of carotid and vertebral artery dissection: a review of the medical literature. AJR Am J Roentgenol. 193(4):1167-74, 2009
                                            23. Provenzale JM: MRI and MRA for evaluation of dissection of craniocerebral arteries: lessons from the medical literature. Emerg Radiol. 16(3):185-93, 2009
                                            24. Ramphul N et al: Caveats in the management and diagnosis of cerebellar infarct and vertebral artery dissection. Emerg Med J. 26(4):303-4, 2009
                                            25. Richard S et al: Two cases of vertebral artery dissections with late stroke recurrences. J Neuroradiol. 36(3):175-7, 2009
                                            26. Ro A et al: Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage: clinical and histopathological investigations from a medicolegal perspective. J Neurosurg. 110(5):948-54, 2009
                                            27. Tan MA et al: Late complications of vertebral artery dissection in children: pseudoaneurysm, thrombosis, and recurrent stroke. J Child Neurol. 24(3):354-60, 2009
                                            28. Yeh HF et al: Traumatic vertebral artery dissection and Wallenberg syndrome after a motorcycle collision. Am J Emerg Med. 27(1):131, 2009
                                            29. Dirik E et al: Vertebral artery dissection in a patient with Wildervanck syndrome. Pediatr Neurol. 39(3):218-20, 2008
                                            30. Hashimoto M et al: Conservative treatment of ruptured vertebrobasilar dissecting aneurysm. Neurol Sci. 29(4):241-4, 2008
                                            31. Redekop GJ: Extracranial carotid and vertebral artery dissection: a review. Can J Neurol Sci. 35(2):146-52, 2008
                                            32. Rodallec MH et al: Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Radiographics. 28(6):1711-28, 2008
                                            33. Tabatabai G et al: Vertebral artery dissection presenting with ispilateral acute C5 and C6 sensorimotor radiculopathy: A case report. Cases J. 1(1):139, 2008
                                            34. Rabinov JD et al: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol. 24(7): 1421-8, 2003
                                            35. Shin JH et al: Vertebral artery dissection: spectrum of imaging findings with emphasis on angiography and correlation with clinical presentation. Radiographics. 20(6): 1687-96, 2000
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Vertebral artery (VA) dissection
                                                        • Definitions

                                                          • Irregularity of VA contour from intimal tear or subadventitial hematoma

                                                        IMAGING

                                                        • General Features

                                                          • CT Findings

                                                            • MR Findings

                                                              • Angiographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Kidoh M et al: MR diagnosis of vertebral artery dissection: value of 3D time-of-flight and true fast imaging with steady-state precession fusion imaging. Insights Imaging. 4(1):135-42, 2013
                                                                                      2. Ahn SS et al: Spontaneous symptomatic intracranial vertebrobasilar dissection: initial and follow-up imaging findings. Radiology. 264(1):196-202, 2012
                                                                                      3. Burlew CC et al: Blunt cerebrovascular injuries: redefining screening criteria in the era of noninvasive diagnosis. J Trauma Acute Care Surg. 72(2):330-5; discussion 336-7, quiz 539, 2012
                                                                                      4. Gottesman RF et al: Clinical characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist. 18(5):245-54, 2012
                                                                                      5. Gottesman RF et al: Imaging characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist. 18(5):255-60, 2012
                                                                                      6. Hongo H et al: Dermatomal Sensory Manifestations in Lateral Medullary Infarction. J Stroke Cerebrovasc Dis. 2012 Oct 22. doi:pii: S1052-3057(12)00320-5. 10.1016/j. jstrokecerebrovasdis. Epub ahead of print, 2012
                                                                                      7. Haynes MJ et al: Assessing the risk of stroke from neck manipulation: a systematic review. Int J Clin Pract. 66(10):940-7, 2012
                                                                                      8. Kennedy F et al: Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology. 79(7):686-9, 2012
                                                                                      9. Matsukawa H et al: Differences in Vertebrobasilar Artery Morphology between Spontaneous Intradural Vertebral Artery Dissections with and without Subarachnoid Hemorrhage. Cerebrovasc Dis. 34(5-6):393-399, 2012
                                                                                      10. Fusco MR et al: Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery. 68(2):517-30; discussion 530, 2011
                                                                                      11. Fusco MR et al: Cerebrovascular dissections--a review part I: spontaneous dissections. Neurosurgery. 68(1):242-57; discussion 257, 2011
                                                                                      12. Burlew CC et al: Blunt cerebrovascular trauma. Curr Opin Crit Care. Epub ahead of print, 2010
                                                                                      13. Campbell-Lloyd AJ et al: Vertebral artery dissection after direct laryngoscopy: case report and literature review. J Laryngol Otol. 123(2):e11, 2009
                                                                                      14. Kawakami Y et al: An 8-year-old boy with vertebral artery dissection with cerebellar ataxia featuring suspected vertebral artery hypoplasia. Brain Dev. 31(4):326-30, 2009
                                                                                      15. Kesser BW et al: Contemporary management of penetrating neck trauma. Am Surg. 75(1):1-10, 2009
                                                                                      16. Kocaeli H et al: Spontaneous intradural vertebral artery dissection: a single-center experience and review of the literature. Skull Base. 19(3):209-18, 2009
                                                                                      17. Koh JS et al: Bilateral vertebral-artery-dissecting aneurysm causing subarachnoid hemorrhage cured by staged endovascular reconstruction after occlusion. Cerebrovasc Dis. 27(2):202-4, 2009
                                                                                      18. Kulcsar Z et al: Vertebral artery dissection as an extremely rare cause of spinal epidural hematoma: case report and review of the literature. Acta Neurochir (Wien). 151(10):1319-23, 2009
                                                                                      19. Lee CK et al: Traumatic vertebral artery injury: detailed clinicopathologic and morphometric analysis of 6 cases. Am J Forensic Med Pathol. 30(2):134-6, 2009
                                                                                      20. Lum C et al: Vertebral artery dissection with a normal-appearing lumen at multisection CT angiography: the importance of identifying wall hematoma. AJNR Am J Neuroradiol. 30(4):787-92, 2009
                                                                                      21. Park SI et al: Clinical and angiographic follow-up of stent-only therapy for acute intracranial vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol. 30(7):1351-6, 2009
                                                                                      22. Provenzale JM et al: Comparison of test performance characteristics of MRI, MR angiography, and CT angiography in the diagnosis of carotid and vertebral artery dissection: a review of the medical literature. AJR Am J Roentgenol. 193(4):1167-74, 2009
                                                                                      23. Provenzale JM: MRI and MRA for evaluation of dissection of craniocerebral arteries: lessons from the medical literature. Emerg Radiol. 16(3):185-93, 2009
                                                                                      24. Ramphul N et al: Caveats in the management and diagnosis of cerebellar infarct and vertebral artery dissection. Emerg Med J. 26(4):303-4, 2009
                                                                                      25. Richard S et al: Two cases of vertebral artery dissections with late stroke recurrences. J Neuroradiol. 36(3):175-7, 2009
                                                                                      26. Ro A et al: Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage: clinical and histopathological investigations from a medicolegal perspective. J Neurosurg. 110(5):948-54, 2009
                                                                                      27. Tan MA et al: Late complications of vertebral artery dissection in children: pseudoaneurysm, thrombosis, and recurrent stroke. J Child Neurol. 24(3):354-60, 2009
                                                                                      28. Yeh HF et al: Traumatic vertebral artery dissection and Wallenberg syndrome after a motorcycle collision. Am J Emerg Med. 27(1):131, 2009
                                                                                      29. Dirik E et al: Vertebral artery dissection in a patient with Wildervanck syndrome. Pediatr Neurol. 39(3):218-20, 2008
                                                                                      30. Hashimoto M et al: Conservative treatment of ruptured vertebrobasilar dissecting aneurysm. Neurol Sci. 29(4):241-4, 2008
                                                                                      31. Redekop GJ: Extracranial carotid and vertebral artery dissection: a review. Can J Neurol Sci. 35(2):146-52, 2008
                                                                                      32. Rodallec MH et al: Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Radiographics. 28(6):1711-28, 2008
                                                                                      33. Tabatabai G et al: Vertebral artery dissection presenting with ispilateral acute C5 and C6 sensorimotor radiculopathy: A case report. Cases J. 1(1):139, 2008
                                                                                      34. Rabinov JD et al: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol. 24(7): 1421-8, 2003
                                                                                      35. Shin JH et al: Vertebral artery dissection: spectrum of imaging findings with emphasis on angiography and correlation with clinical presentation. Radiographics. 20(6): 1687-96, 2000