Middle aged man with recurrent vertebral artery dissection

Case presentation: A 50 years old man suffering from diabetes, was admitted in emergency room due to vertigo, diplopia, nausea and vomiting. He was evaluated by brain MRI and a small lacunar infarct in lateral medulla was detected. Echocardiography and color Doppler sonography were done without any finding. He was discharged with oral Aspirin, Plavix and Atorvastatin. The neurological recovery was not completed.. He came to emergency room 2 weeks later with exaggerated vertigo and hiccup. He was admitted again and evaluated by MRI. In new MRI, the former CVA progressed and signs of dissection were found in left vertebral artery. In retrograde analysis of the last MRI, dissection was seen which had progressed in new imaging. Brain MR Angiography confirmed the diagnosis. Consultation with neuro-interventionist was performed and medical treatment was continued. Patient was visited one month later with significant improvement. No previous disease was found Discussion: The risk of recurrence in cervical artery dissection (CAD) is low, approximately 0-13 % without any specification for vertebral artery. It seems to be more frequent within the first 2 months after the initial event and some dissections that were diagnosed as multiple might have occurred sequentially within a short time frame. Risk factors for recurrent CAD are younger age, a family history of CAD, vascular Ehlers-Danlos syndrome and fibromuscular dysplasia. Early recurrences of dissection in the weeks after the initial event could be a manifestation of a unique transient disorder, whereas late recurrences occurring several months or years later could indicate an underlying connective tissue weakness. The prognosis of recurrent CAD has been described as benign

کلیدواژه ها:

vertebral ، artery ، dissection ، recurrent