Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 68
Filter
1.
Rev. Assoc. Med. Bras. (1992) ; 66(10): 1351-1354, Oct. 2020. graf
Article in English | LILACS, SES-SP | ID: biblio-1136158

ABSTRACT

SUMMARY Vertebral Artery Dissection (VAD) is a rare condition that can be caused by a wide amplitude of neck movement, which injures the vessel wall and can cause ischemia in the cerebellum. We present a 37-year-old man with herniated lumbar disc and allergic rhinosinusitis, which caused sneezing spells. After one of these bouts with a ricochet of the head, he presented C3 misalignment with local pain. Twenty-one days later, affected by a new crisis, he presented left temporal headache, nystagmus, and vertigo. After 3 days, Magnetic Resonance Imaging (MRI) identified 2 regions of cerebellar ischemia and filling failure of the right vertebral artery. After 2 days, Computed Angiotomography (CT Angiography) was performed and showed right VAD with a local thrombus, without aneurysmal signs. Transcranial Doppler did not indicate an increase in blood flow from this artery. The suggested treatment involved administration of anticoagulant Apixabana 5mg, 12/12h, for 3 months, until the condition was reevaluated with new Angio CT and MRI. It was recommended that the patient was released from work for 1 month and forbidden from doing intense physical exercises for 3 months; however, due to setbacks, these deadlines were extended until a new appointment, 4 months after the first visit. The new tests showed no changes, indicating that the condition was stable. This case aims to indicate the possible investigations of the diagnosis and therapeutic options of the rare association between VAD with cerebellar infarction in a well-documented case.


RESUMO A Dissecção da Artéria Vertebral (DAV) é quadro raro que pode ser causado por movimentação de grande amplitude do pescoço, que lesiona a parede desse vaso, podendo provocar isquemia no cerebelo. Apresentamos um homem de 37 anos, com hérnia de disco e rinossinusite alérgica que lhe causava crises de espirros em salva (CE). Após uma dessas crises com ricocheteamento da cabeça, apresentou desalinhamento de C3 com dor local. Vinte e um dias depois, acometido por nova crise, apresentou cefaleia temporal esquerda, nistagmo e vertigem. Decorridos 3 dias, o paciente foi submetido a Ressoânncia Magnética (RM), que identificou 2 regiões de isquemia cerebelar e enchimento comprometido da artéria vertebral direita. Após 2 dias, foram feitos Angiotomografia Computadorizada (Angio TC), que constatou DAV direita com trombo local, sem sinais aneurismáticos, e Doppler Transcraniano, que não indicou aumento do fluxo sanguíneo dessa artéria. O tratamento sugerido envolvia administração de anticoagulante Apixabana 5mg, 12/12h, por 3 meses, até que o quadro fosse reavaliado com novas Angio TC e RM. Foi recomendado que o paciente ficasse afastado do trabalho por 1 mês e de exercícios físicos intensos por 3 meses, porém devido a contratempos, esses prazos foram prorrogados até nova consulta, 4 meses após a primeira. Os novos exames não apresentaram alterações, indicando que o quadro estava estável. Esse caso tem como objetivo indicar as possíveis investigações do diagnóstico e opções terapêuticas da rara associação entre DAV com infarto cerebelar em caso bem documentado.


Subject(s)
Humans , Male , Adult , Cerebellar Diseases , Vertebral Artery Dissection/etiology , Vertebral Artery Dissection/diagnostic imaging , Sneezing , Vertebral Artery , Magnetic Resonance Imaging , Infarction
2.
Arq. neuropsiquiatr ; 77(9): 632-637, Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038746

ABSTRACT

ABSTRACT Cervical arterial dissection accounts for only a small proportion of ischemic stroke but arouses scientific interest due to its wide clinical variability. Objective: This study aimed to evaluate its risk factors, outline its clinical characteristics, compare treatment with antiaggregation or anticoagulation, and explore the prognosis of patients with cervical arterial dissection. Methods: An observational, retrospective study using data from medical records on patients with cervical arterial dissection between January 2010 and August 2015. Results: The total number of patients was 41. The patients' ages ranged from 19 to 75 years, with an average of 44.5 years. The most common risk factor was smoking. Antiaggregation was used in the majority of patients (65.5%); 43% of all patients recanalized in six months, more frequently in patients who had received anticoagulation (p = 0.04). Conclusion: The presence of atherosclerotic disease is considered rare in patients with cervical arterial dissection; however, our study found a high frequency of hypertension, smoking and dyslipidemia. The choice of antithrombotic remains controversial and will depend on the judgment of the medical professional; the clinical results with anticoagulation or antiaggregation were similar but there was more recanalization in the group treated with anticoagulation; its course was favorable in both situations. The recurrence of cervical arterial dissection and stroke is considered a rare event and its course is favorable.


RESUMO As dissecções arterais cervicais correspondem somente a uma pequena proporção dos casos de acidente vascular cerebral (AVC) isquêmico, mas despertam interesse científico devido à sua alta variabilidade clínica. Objetivos: Este estudo destina-se a avaliar os fatores de risco, desfechos clínicos, comparar o tratamento com anticoagulação e antiagregação, e avaliar o prognóstico desses pacientes. Métodos: Estudo observacional, retrospectivo utilizando dados de prontuários de pacientes com dissecção arterial cervical entre os períodos de janeiro de 2010 e agosto de 2015. Resultados: O número de pacientes foi 41. A idade foi de 19 a 75 anos, com idade média de 44,5 anos. O fator de risco mais comum encontrado foi o tabagismo. Antiagregação foi utilizada na maioria dos pacientes (65,5%); 43% dos pacientes apresentaram recanalização em seis meses, sendo esta mais frequentemente observada nos pacientes que receberam anticoagulação (p = 0,04). Conclusão: A presença de doença aterosclerótica é considerada rara em pacientes com dissecção arterial cervical. Entretanto, nosso estudo encontrou alta frequência de hipertensão arterial, tabagismo e dislipidemia. A escolha pela terapia antitrombótica permanece controversa e dependerá do julgamento clínico do médico; os resultados clínicos com anticoagulação ou antiagregação foram similares, mas houve maior taxa de recanalização no grupo tratado com anticoagulação. A recorrência de dissecação arterial cervical e AVC foi considerada rara e o curso, favorável.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Vertebral Artery Dissection/etiology , Vertebral Artery Dissection/drug therapy , Prognosis , Time Factors , Severity of Illness Index , Brazil/epidemiology , Platelet Aggregation Inhibitors/therapeutic use , Carotid Artery Diseases/etiology , Carotid Artery Diseases/drug therapy , Carotid Artery Diseases/epidemiology , Smoking/adverse effects , Retrospective Studies , Risk Factors , Treatment Outcome , Stroke/etiology , Stroke/epidemiology , Vertebral Artery Dissection/epidemiology , Atherosclerosis/etiology , Anticoagulants/therapeutic use
3.
Article in Korean | WPRIM | ID: wpr-766824

ABSTRACT

BACKGROUND: The patients with familial hypercholesterolemia (FH) suffer from early onset atherosclerotic vascular disease due to high level of cholesterol and subsequent vascular inflammation, especially in the form of coronary artery disease. We investigated the clinical characteristics of FH associated cerebral infarction and its possible mechanism. METHODS: Between January 2014 and May 2017, acute cerebral infarction patients who admitted to Chung-Ang University Hospital were reviewed from stroke registry and the diagnosis of FH was made based on the Dutch Lipid Clinic Network Diagnostic Criteria for FH. We reviewed their initial laboratory and brain imaging information, prescribed medication and followed lipid profile after discharge. Stroke mechanism was determined based on Trial of ORG 10172 in Acute Stroke Treatment classification. RESULTS: Among 1,401 acute cerebral infarction or transient ischemic attack patients, one probable and three possible FH stroke patients were detected. All the patients denied of previous coronary artery disease history and initial lipid panel revealed high levels of total cholesterol (378±75 mg/dL) and low-density lipoprotein-cholesterol (238±56 mg/dL). Stroke mechanisms were heterogeneous, including one atherosclerotic, two vertebral artery dissection cases and one coagulation disorder. All the patients were combined with noticeable degree of intracranial atherosclerosis and were maintained with statin treatment. CONCLUSIONS: This study illustrates diverse stroke mechanism among stroke patients with FH. Further research is required to disclose exact incidence of FH among stroke population and effective treatment strategy.


Subject(s)
Atherosclerosis , Cerebral Infarction , Cholesterol , Classification , Coronary Artery Disease , Diagnosis , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Hyperlipoproteinemia Type II , Incidence , Inflammation , Intracranial Arteriosclerosis , Ischemic Attack, Transient , Neuroimaging , Stroke , Vascular Diseases , Vertebral Artery Dissection
4.
Article in Korean | WPRIM | ID: wpr-766744

ABSTRACT

We describe a case of vertebral artery dissection (VAD) presenting with acute infarctions in cervical spinal cord and cerebellum in a 78-year-old man. Diffusion-weighted magnetic resonance (MR) imaging of the brain demonstrated diffusion-restricted lesions in the right cerebellum and sagittal T2-weighted MR imaging of spinal cord showed a hyperintense lesion of the cervical spinal cord at C2-C4 level. Right VAD was identified by transfemoral cerebral angiography and computed tomography angiography which showed segmental occlusion in the right vertebral artery.


Subject(s)
Aged , Angiography , Brain , Cerebellum , Cerebral Angiography , Cervical Cord , Humans , Infarction , Magnetic Resonance Imaging , Spinal Cord , Spinal Cord Ischemia , Vertebral Artery Dissection , Vertebral Artery
5.
Article in English | WPRIM | ID: wpr-764179

ABSTRACT

Although many imaging modalities can play some roles in the diagnosis of vertebral artery dissection (VAD), digital subtraction angiography (DSA) remains the gold standard method, with the highest detection rate and ability to assist in planning for endovascular treatment. However, this tool is often avoided in children because its invasive nature and it exposes them to radiation. High resolution magnetic resonance imaging (HR-MRI) have been suggested to be a reliable and non-invasive alternative, but it has never been discussed in children in whom vertebral artery dissection is a rare condition. In this report, we evaluate a case of a 2-year-old child who initially presented with cerebellar symptoms, and was early diagnosed with vertebral artery dissection using HR-MRI and was successfully treated.


Subject(s)
Angiography, Digital Subtraction , Child , Child, Preschool , Diagnosis , Humans , Magnetic Resonance Imaging , Methods , Vertebral Artery Dissection , Vertebral Artery
6.
Article in English | WPRIM | ID: wpr-772804

ABSTRACT

MASSAGE has been recommended to more people as an adjunct to health care. We illustrate a case of vertebral artery dissection (VAD) probably caused by massage that almost resulted in the patient's death. The patient experienced sudden cardiac arrest and paralysis. After treatment with anticoagulation and antiplatelet, he finally discharged without any sequelae.


Subject(s)
Anticoagulants , Humans , Male , Massage , Middle Aged , Platelet Aggregation Inhibitors , Vertebral Artery Dissection , Drug Therapy
7.
Article in Korean | WPRIM | ID: wpr-766641

ABSTRACT

The pathophysiology of reversible cerebral vasoconstriction syndrome (RCVS) is not known but coexisting vascular lesion, such as carotid artery and vertebral artery dissection, has been reported. However, RCVS concurrent with anterior cerebral artery dissection has never been reported. We describe a 28-year old patient presenting with anterior cerebral artery dissection with RCVS associated with coughing. This case could support the causality between RCVS and arterial dissection.


Subject(s)
Anterior Cerebral Artery , Carotid Arteries , Cough , Headache Disorders, Primary , Humans , Vasoconstriction , Vertebral Artery Dissection
8.
Article in English | WPRIM | ID: wpr-715730

ABSTRACT

No abstract available.


Subject(s)
Vertebral Artery Dissection , Vertebral Artery
11.
Arq. bras. neurocir ; 36(1): 43-46, 06/03/2017.
Article in English | LILACS | ID: biblio-911128

ABSTRACT

Vertebral artery dissection (VAD) is a rare and sometimes unrecognized cause of stroke in patients younger than 45 years. Herein, we describe a very rare case of bilateral vertebral artery dissection after a session of cervical therapy manipulation (chiropractic).


Vertebral artery dissection (VAD) is a rare and sometimes unrecognized cause of stroke in patients younger than 45 years. Herein, we describe a very rare case of bilateral vertebral artery dissection after a session of cervical therapy manipulation (chiropractic).


Subject(s)
Humans , Female , Adult , Vertebral Artery Dissection , Manipulation, Chiropractic/adverse effects
12.
The Ewha Medical Journal ; : 128-135, 2017.
Article in Korean | WPRIM | ID: wpr-166008

ABSTRACT

OBJECTIVES: Although there have been several reports that described characteristics for young age stroke, information regarding very young age (18–30 years old) has been limited. We aimed to analyze demographic factors, stroke subtype, and 3-month outcome in acute ischemic stroke patient who have relatively very young age in multicenter stroke registry. METHODS: We evaluated all 122 (7.1%) consecutive acute ischemic stroke (within 7 days after symptom onset) patients aged 18 to 30 from 17,144 patients who registered in multicenter prospective stroke registry, 1997 to 2012. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria. Stroke severity was defined as National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was defined by modified Rankin scale (mRS) at 3 months after index stroke. RESULTS: The mean age of all included patients was 25.1±3.7 years and 76 patients (62.2%) were male. The median NIHSS at admission was 4. Considering stroke subtype, 37 patients (30.3%) had stroke of other determined etiology (SOD), 37 (30.3%) had undetermined negative evaluation (UN) and 31 (25.4%) had cardioembolism (CE) were frequently noted. After adjusting age, sex and variables which had P<0.1 in univariable analysis (NIHSS and stroke subtype), CE stroke subtype (odds ratio, 4.68; 95% confidence interval, 1.42–15.48; P=0.011) were significantly associated with poor functional outcome (mRS≥3). CONCLUSION: In very young age ischemic stroke patients, SOD and UN stroke subtype were most common and CE stroke subtype was independently associated with poor discharge outcome.


Subject(s)
Carotid Artery, Internal, Dissection , Cerebral Infarction , Demography , Humans , Male , Prognosis , Prospective Studies , Stroke , United Nations , Vertebral Artery Dissection
14.
Rev. neuropsiquiatr ; 79(4): 272-276, oct.-dic. 2016. ilus
Article in Spanish | LILACS, LIPECS | ID: biblio-836267

ABSTRACT

La disección cervical es una entidad poco estudiada y diagnosticada como variante de infarto cerebral, sobretodo en el adulto joven; es, sin embargo, relativamente frecuente y debe formar parte del diagnóstico diferencialen pacientes jóvenes con infarto cerebral de mecanismo embólico. Se presenta el caso clínico de una paciente coninfarto cerebral en diferentes territorios vasculares: varios estudios de ayuda diagnóstica resultaron en la detecciónde compromiso de la arteria vertebral izquierda por disección arterial, mediante protocolos especiales de resonanciamagnética cervical.


Cervical dissection is a poorly studied and diagnosed entity, a variant of cerebral infarction particularly foundamong young adults. It is, however, relatively frequent and should be suspected as a differential diagnosis in young patients with history of an embolic stroke. The clinical case of a patient with cerebral infarction of different vascular territories is presented: various diagnostic studies resulted in the detection of involvement of the left vertebral artery by arterial dissection, by special protocols of cervical magnetic resonance.


Subject(s)
Humans , Female , Middle Aged , Vertebral Artery Dissection , Cerebral Infarction
15.
Arq. neuropsiquiatr ; 74(4): 275-279, Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-779813

ABSTRACT

Dissection of cervical arteries constitutes a medical emergency. Although relatively rarely, activities classified as sports and recreation may be a cause of arterial dissection independently of neck or head trauma. The purpose of the present paper was to present a series of cases of cerebrum-cervical arterial dissection in individuals during or soon after the practice of these sports activities. Methods Retrospective data on patients with arterial dissection related to sports and recreation. Results Forty-one cases were identified. The most frequently affected vessel was the vertebral artery. A large variety of activities had a temporal relationship to arterial dissection, and jogging was the most frequent of these. This is the largest case series in the literature. Conclusion Arterial dissection may be a complication from practicing sports.


A dissecção das artérias cervicais é uma emergência médica. Embora de forma relativamente rara, certas atividades descritas como esportes e recreação podem ser a causa de dissecção arterial independentemente de trauma de crânio ou cervical. O propósito do presente estudo é apresentar uma série de casos de dissecção de artérias cérebro-cervicais em indivíduos durante ou logo após a prática destas atividades desportivas. Métodos Dados retrospectivos de pacientes com dissecção arterial relacionada à prática de esportes e recreação. Resultados Quarenta e um casos foram identificados. A artéria mais frequentemente afetada foi a vertebral. Uma grande variedade de atividades teve relação temporal com a dissecção arterial, sendo a corrida a mais frequente delas. Esta é a maior série de casos da literatura. Conclusão Dissecção arterial pode ser uma complicação da prática de esportes.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Athletic Injuries/complications , Carotid Artery, Internal, Dissection/etiology , Recreation , Sports/statistics & numerical data , Vertebral Artery Dissection/etiology , Cerebral Angiography , Carotid Artery, Internal, Dissection/pathology , Headache/etiology , Retrospective Studies , Risk Factors , Stroke/etiology , Vertebral Artery Dissection/pathology
17.
Rev. bras. cir. cardiovasc ; 31(1): 52-59, Jan.-Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-778374

ABSTRACT

Abstract Aberrant origin of vertebral artery is rare. The anatomical features and clinical significance of this lesion remain to be clarified. A comprehensive collection of the pertinent literature resulted in a cohort of 1286 cases involving 955 patients and 331 cadavers. There were more left than right and more unilateral than bilateral aberrant vertebral arteries. Patients with aberrant origin of vertebral artery were often asymptomatic and in only 5.5% of the patients their symptoms were probably related to the aberrant origin of vertebral artery. The acquired cardiovascular lesions were present in 9.5% of the patients, 20.9% of which were vertebral artery-associated lesions. Eight (0.8%) patients had a vertebral artery dissection. Logistic regression analysis showed significant regressions between bovine trunk and left vertebral artery (P=0.000), between the dual origins of vertebral artery and cerebral infarct/thrombus (P=0.041), between associated alternative congenital vascular variants and cervical/aortic dissection/atherosclerosis (P=0.008). Multiple logistic regression demonstrated that side of the aberrant origin of vertebral artery (left vertebral artery) (P=0.014), arch branch pattern (direct arch origin) (P=0.019), presence of the common trunk (P=0.019), associated acquired vascular disorder (P=0.034) and the patients who warranted management (P=0.000) were significant risk predictors for neurological sequelea. The patients with neurological symptoms and those for neck and chest operations/ interventions should be carefully screened for the possibility of an aberrant origin of vertebral artery. The results from the cadaver metrology study are very helpful in the design of the aortic stent. The arch branch pattern has to be taken into consideration before any maneuver in the local region so as to avoid unexpected events in relation to aberrant vertebral artery.


Subject(s)
Female , Humans , Male , Aorta, Thoracic/abnormalities , Subclavian Artery/abnormalities , Vertebral Artery/abnormalities , Aorta, Thoracic/pathology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/pathology , Nervous System Diseases/etiology , Nervous System Diseases/pathology , Risk Factors , Subclavian Artery/pathology , Vascular Malformations/complications , Vertebral Artery Dissection/etiology , Vertebral Artery Dissection/pathology , Vertebral Artery/pathology
18.
Article in Chinese | WPRIM | ID: wpr-239553

ABSTRACT

A 61-year-old female presented with 4 years history of left-sided hemifacial spasm. Head MRI and angiography indicated left vertebral artery dissecting aneurysm which compressed ipsilateral cranial nerves Ⅶ and Ⅷ. Microvascular decompression was performed. The dissecting aneurysm was pushed apart and the distal part of the parent artery was adhered to the dura on the petrosum. The compressed nerves were totally decompressed. The symptom of facial spasm was completely resolved immediately after surgery and did not recur during 6 months of follow up.


Subject(s)
Cerebral Angiography , Facial Nerve , Pathology , Female , Hemifacial Spasm , General Surgery , Humans , Magnetic Resonance Imaging , Microvascular Decompression Surgery , Middle Aged , Nerve Compression Syndromes , Diagnosis , General Surgery , Vertebral Artery Dissection , Diagnostic Imaging , General Surgery , Vestibulocochlear Nerve , Pathology
19.
Article in English | WPRIM | ID: wpr-167778

ABSTRACT

We report a case of multiple symptomatic cerebral infarctions from a traumatic vertebral artery dissection (VAD) after cervical fractures. A 73-year-old man was admitted with stuporous mentality and left hemiparesis after a motor-vehicle accident. A brain computed tomography (CT) scan at admission showed a traumatic subarachnoid hemorrhage on the left parietal lobe. A cervical CT scan showed left lateral mass fractures on C2, C5, and C6, involving the transverse foramen. Cervical spine magnetic resonance imaging (MRI) revealed loss of signal void on the left vertebral artery. Neck CT angiography showed left VAD starting at the C5 level. Brain MRI revealed acute, multiple cerebral infarctions involving the pons, midbrain, thalamus, corpus callosum, and parietal and frontal lobes on diffusion weighted images. The patient was treated conservatively at the intensive care unit in the acute stage to prevent extent of stroke. Aspirin was started for antiplatelet therapy in the chronic stage. The possibility of symptomatic cerebral infarctions due to traumatic VAD following cervical fracture should be considered.


Subject(s)
Aged , Angiography , Aspirin , Brain , Cerebral Infarction , Cervical Vertebrae , Corpus Callosum , Diffusion , Female , Frontal Lobe , Humans , Intensive Care Units , Magnetic Resonance Imaging , Mesencephalon , Neck , Paresis , Parietal Lobe , Pons , Rabeprazole , Spinal Fractures , Spine , Stroke , Stupor , Subarachnoid Hemorrhage, Traumatic , Thalamus , Tomography, X-Ray Computed , Vertebral Artery , Vertebral Artery Dissection
20.
Article in English | WPRIM | ID: wpr-65757

ABSTRACT

Neurofibromatosis 1 (NF1) is a common autosomal dominant disorder that causes several systemic diseases. Many studies have reported that NF1 is associated with intrathoracic meningoceles and scoliosis. The incidence of vertebral artery dissection is estimated to be 1-1.5 per 100,000 population. We experienced an autopsy case of massive intrathoracic hemorrhage due to spontaneous vertebral artery dissection in a patient with NF1, who had intrathoracic spinal meningoceles and scoliosis. A 47-year-old man was found dead at his home in the morning. He had a history of NF1 including numerous cutaneous neurofibromas and hyperpigmented macules, scoliosis, and deformity of the leg. The autopsy revealed the dissection and rupture of the left vertebral artery, and a pseudocyst that had formed due to arterial leakage on the wall of the meningocele on the left side. The pseudocyst had eventually ruptured and leaked blood, resulting in a massive hemothorax on the left side. Thus, it was revealed that the patient had suffered from NF1-associated intrathoracic meningoceles and scoliosis, and we concluded that the cause of his death was a massive hemothorax on the left side, caused by the dissection and rupture of the left vertebral artery.


Subject(s)
Autopsy , Congenital Abnormalities , Hemorrhage , Hemothorax , Humans , Incidence , Leg , Meningocele , Middle Aged , Neurofibroma , Neurofibromatoses , Neurofibromatosis 1 , Rupture , Scoliosis , Vertebral Artery Dissection , Vertebral Artery
SELECTION OF CITATIONS
SEARCH DETAIL