Vertebral Artery Dissection: Warning Symptoms, Clinical Features and Prognosis in 26 Patients

Table 1: Cumulative symptoms*

Symptom

No. of Patients

Approx. Percentages

Pain

22

88%

Only neck pain

4

15%

Only headache

13

50%

Both

5

19%

Headache by location:

..

..

Occipital

12

..

Maxillary

1

..

Temporal

2

..

Others

3

..

Dizziness/vertigo

15

57%

Nausea/vomiting

14

53%

Unilateral facial numbness

12

46%

Unsteadiness

11

42%

Diplopia

6

23%

Dysarthria

4

15%

Dysphagia

3

11%

Limb numbness

3

11%

Limb weakness

3

11%

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Table 2: Possible immediate predisposing factors for dissection

Sports activities: 4 patients (15%)

No of patients

While playing golf

1

While playing soccer

1

While running

1

While playing baseball

1

Associated with chiropractic: 3 patients (11%)

No of patients

During or immediately after chiropractic

2

One day after vigorous chiropractic

1

Possible neck injury: 7 patients (26 %)

No of Patients

Snow board accident 12 days prior to stroke

1

Falling on back one day before

1

Car accident 2 weeks before

1

Truck neck accident 3 years previously

1

Minor neck injury 2 weeks before onset

1

During loading truck

1

During vigorous self-manipulation of neck

1

TOTAL

14/26 (53%)

Chronic risk factors

No of patients

Hypertension

4

Diabetes mellitus

3

Smoking

3

Migraine

1

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Table 3: Initial angiographic findings in 25 patients (total dissecting arteries 31)

Abnormality

Number of Arteries(%)

Irregular stenosis without occlusion

17 (54%)

Occlusion with stenosis

13 (42%)

Level of dissection:

.

Extracranial (C1-C2)

16 (51%)

Extracranial (other locations)

7 (22%)

Intracranial dissection

8 (25%)

False aneurysm

6 (19%)

Signs of fibromuscular dysplasia

2 (6%)

Cerebral angiography of 25 patients with VA dissection:

Patients with Unilateral VA dissection

19 (76%)

Patients with Bilateral VA dissection

6 (24%)

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