China
Africa
Explore chapters and articles related to this topic
Case 5: Sudden-Onset Headache
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
Vertebral artery dissection can develop following trauma but may not present until days, or weeks after the event. Symptoms include a sudden-onset occipital headache, often associated with nuchal pain and vomiting. Unilateral cranial nerve impairment may also develop.
Neuroimaging
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
The cardinal sign on cross-sectional imaging of acute arterial dissection is vessel expansion with a crescent of mural thrombus and an eccentrically placed lumen. In internal carotid dissection that extends to the skull base, this is readily visible on the lowermost slice of routine T2-weighted axial brain scans without recourse to special sequences. If in doubt, fat suppressed axial scans through the neck are often diagnostic. The classical angiographic sign of a ‘rat’s tail’ tapered occlusion is often appreciable on CTA or MRA, however in some cases dissection causes little if any luminal narrowing, hence the importance of imaging the vessel wall. Follow up imaging often shows resolution, although some vessel irregularity can persist and false aneurysms may develop. Vertebral artery dissection produces similar signs but can be more difficult to diagnose as the vessels are smaller. The appearance on CTA is analogous, with vessel expansion and a patent eccentric lumen surrounded by non-enhancing mural thrombus.
Neck pain and whiplash
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
Headache is the most common presenting feature of internal carotid artery dissection, but neck pain has been the sole presenting feature in some 6 percent of cases.37, 38 In 17 percent of patients, headache may occur in combination with neck pain.38 Neck pain has been the initial presenting feature in 50–90 percent of patients with vertebral artery dissection, but is usually also accompanied by headache, typically in the occipital region although not exclusively so.37, 39 Although the typical features of dissecting aneurysm of the aorta are chest pain and cardiovascular distress, neck pain has been reported as the presenting feature in some 6 percent of cases.40, 41
Center of pressure velocities in patients with body lateropulsion: three case report series of Wallenberg’s syndrome
Published in Physiotherapy Theory and Practice, 2022
Hideaki Matsuo, Masafumi Kubota, Mayumi Matsumura, Mami Takayama, Yuri Mae, Yuki Kitazaki, Soichi Enomoto, Asako Ueno, Masamichi Ikawa, Tadanori Hamano, Ai Takahashi, Misao Tsubokawa, Seiichiro Shimada
Patient 1 was a 44-year-old man who presented to the emergency department with cold sweats and numbness on the left side. The patient had no underlying disease or smoking habit but reported heavy alcohol consumption every night. Upon arrival, the patient was alert and had apparent right Horner’s syndrome, pain and temperature sensory loss on the left side, hoarseness, torsional nystagmus, velopharyngeal incompetence on the right side, and a National Institutes of Health Stroke Scale (NIHSS) score of 4. Magnetic resonance imaging (MRI) revealed hyperintensity in diffusion-weighted images (DWIs) of the right lateral side of the medulla (Figure 1a). Magnetic resonance angiography revealed a right vertebral artery dissection. The patient’s clinical diagnosis was Wallenberg’s syndrome because of the dissection of the vertebral artery.
Bilateral Fascicular Third Nerve Palsy in Posterior Circulation Stroke
Published in Neuro-Ophthalmology, 2019
Olaf Eberhardt, Mirjam Hermisson, Gisela Eberle-Strauss, Helge Topka
No angiographic or neurosonological pathology affecting the left vertebral artery was shown, in particular no signs of vertebral artery dissection. A diagnostic work-up to identify the source of embolic basilar artery occlusion made a cardioembolic origin probable. Transcranial ultrasound studies after agitated saline had been injected intravenously revealed a single embolic signal at rest and about 20 embolic signals following Valsalva manoeuvre. Right-to-left shunt following Valsalva manoeuvre due to patient foramen ovale was confirmed by transoesophageal echocardiography. A hypermobile septal aneurysm was present, but there was no intracardiac thrombus or aortic atheroma. Left ventricular function and flow velocity in the left atrial appendage were normal. Importantly, no crural venous thrombosis was detected by duplex ultrasonography. Apart from a single supraventricular run over only seven beats no relevant cardiac arrhythmia was detected in several 24-h electrocardiographies. Blood lipids, coagulation screening, and other blood tests were unremarkable, except for slight hyperuricaemia. Therapy with acetylsalicylic acid and a statin was initiated.
“Singultus” uncloaking potentially fatal vascular dissections
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Waqas Ullah, Shristi Khanal, Zeeshan Sattar, Sohaib Roomi, Asrar Ahmad, Usman Sarwar, Ali Raza Ghani
All these cases were reported in male and mostly in their middle aged or old aged. Only one of the reported cases had aortic dissection as the cause of hiccups while the other two cases were of vertebral and carotid dissection. All the cases had an associated risk factor with hypertension present in two cases and one patient had a history of smoking and migraine. Diagnosis was made by CT scan, MRA, and angiography, respectively. Two of the cases had successful recovery with conservative management in the patient with aortic dissection and with possible stenting in the patient with vertebral artery dissection. There was no data available on outcome and management in the patient with carotid artery dissection. Our case marks the fourth case of an arterial dissection associated with hiccups, and the second case of aortic artery dissection presenting with hiccups. Our patient was unique in terms of presentation as he was having intractable hiccups and gastrointestinal symptoms like nausea and vomiting.