Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Traumatic extracranial vertebral artery dissection treated with coil embolization -a case report-

Daisuke Matsuura, M.D.1)2), Yuichiro Inatomi, M.D.1), Hiroko Saeda, M.D.1), Toshiro Yonehara, M.D.1), Shodo Fujioka, M.D.1), Yutaka Kai, M.D.3), Jun-ichiro Hamada, M.D.3), Yoichiro Hashimoto, M.D.4), Teruyuki Hirano, M.D.5) and Makoto Uchino, M.D.5)

1)Stroke Center, Saiseikai Kumamoto Hospital
2)Department of Neurology, Oota Memorial Hospital
3)Department of Neurosurgery, Postgraduate School of Medical Sciences, Kumamoto University
4)Department of Neurology, Kumamoto City Hospital
5)Department of Neurology, Postgraduate School of Medical Sciences, Kumamoto University

We reported a 37-year-old man who developed vertigo, dysarthria and left hemiparesis following neck pain. Magnetic resonance imaging (MRI) demonstrated infarct in the right superior cerebellar artery (SCA) territory. Duplex color-flow imaging detected dissection (double lumen) in the right vertebral artery (VA) at the level of the C4-C6 vertebra (V2 segment). Cerebral angiography showed irregular narrowing in the right V2, and occlusion of the right SCA. These findings suggested that dissection in the right V2 caused artery-to-artery embolism in the right SCA.
Despite administration of anti-thrombotic agents, he recurrently suffered from transient ischemic attacks. Serial duplex color-flow imaging echography revealed that the dissection of the right VA gradually became more stenotic and extended to the distal site. Coil-embolization of the right VA by endovascular therapy was performed, and thereafter the dissecting lesion of the right VA was completely occluded and ischemic attacks disappeared.

(CLINICA NEUROL, 45: 298|303, 2005)
key words: extracranial vertebral artery dissection, brain infarction, endovascular therapy, coil embolization

(Received: 20-Apr-04)