ABSTRACT
Twelve patients (mean age 36,0+/-10,4 years) with a vertebral artery dissection (VAD) were followed-up during 2,5 months - 5 years. All patients underwent magnetic resonance (MR) imaging of the head, MR-angiography (11 patients - repeated studies), 5 patients - conventional cerebral angiography. VAD was located on extracranial (7), intracranial (1), extra-intracranial levels (4), the extension of dissection to the basilar artery was found in 2 patients. Dissection involving both vertebral arteries was observed in 6 patients, recurrent VAD after 4-15 months - in 3 patients. A total number of VAD was 22, a total number of cerebrovascular events - 15. The latter included ischemic strokes (13), transient ischemic attacks (1) and isolated headache (1). Ischemic cerebrovascular events were characterized by the combination of cerebral ischemic symptoms with occipital headache and/or posterior neck pain (79%) which usually preceded ischemic cerebral symptoms by the interval of several hours - 3 weeks as well as a goof recovery of neurological deficit (92%). In a half of patients, cerebral ischemic symptoms developed after neck movements or manual therapy. Angiography revealed the stenosis of vertebral arteries, usually elongated, irregular or tapered (64%), more often located at the level of V3-V4 segments, vertebral artery occlusion (36%) and pseudoaneurisms (19%). The repeated angiography performed in 2-3 months or more showed positive changes in 82%, the complete (86%) or partial (14%) resolution of all stenoses and the complete or partial recanalization of the half of vertebral artery occlusions, the regress of all pseudoaneurisms. An intramural hematoma on MR imaging (the axial plane) was found in 85% dissections analyzed, the increased vertebral artery outer diameter - in 69%. Atherosclerotic plaques were absent in all cases. VAD is one of unknown causes of ischemic stroke in vertebrobasilar circulation. Diagnosis is based on characteristic clinical and angiography data.
