Hai-Bin Zhang, Yong-Hong Duan, Min Zhou, Ri-Chu Liang
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High-resolution magnetic resonance imaging (HRMRI) has emerged as a reliable diagnostic tool for VAD, providing detailed visualization of vessel wall abnormalities.</p><p><strong>Case summary: </strong>A young male patient presented with an acute onset of severe headache, vomiting, and seizures, followed by altered consciousness. Imaging studies revealed bilateral VAD, basilar artery thrombosis, multiple brainstem and cerebellar infarcts, and subarachnoid hemorrhage. Digital subtraction angiography (DSA) revealed vertebral artery stenosis but failed to detect the dissection, potentially because intramural thrombosis obscured the VAD. In contrast, HRMRI confirmed the diagnosis by revealing specific signs of dissection. The patient was managed conservatively with antiplatelet therapy and other supportive measures, such as blood pressure control and pain management. After 5 mo of rehabilitation, the patient showed significant improvement in swallowing and limb strength.</p><p><strong>Conclusion: </strong>HR-MRI can provide precise evidence for the identification of VAD.</p>","PeriodicalId":23819,"journal":{"name":"World journal of radiology","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11525835/pdf/","citationCount":"0","resultStr":"{\"title\":\"High-resolution magnetic resonance imaging in the diagnosis and management of vertebral artery dissection: A case report.\",\"authors\":\"Hai-Bin Zhang, Yong-Hong Duan, Min Zhou, Ri-Chu Liang\",\"doi\":\"10.4329/wjr.v16.i10.593\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Vertebral artery dissection (VAD) is a rare but life-threatening condition characterized by tearing of the intimal layer of the vertebral artery, leading to stenosis, occlusion or rupture. The clinical presentation of VAD can be heterogeneous, with common symptoms including headache, dizziness and balance problems. Timely diagnosis and treatment are crucial for favorable outcomes; however, VAD is often missed due to its variable clinical presentation and lack of robust diagnostic guidelines. High-resolution magnetic resonance imaging (HRMRI) has emerged as a reliable diagnostic tool for VAD, providing detailed visualization of vessel wall abnormalities.</p><p><strong>Case summary: </strong>A young male patient presented with an acute onset of severe headache, vomiting, and seizures, followed by altered consciousness. Imaging studies revealed bilateral VAD, basilar artery thrombosis, multiple brainstem and cerebellar infarcts, and subarachnoid hemorrhage. Digital subtraction angiography (DSA) revealed vertebral artery stenosis but failed to detect the dissection, potentially because intramural thrombosis obscured the VAD. In contrast, HRMRI confirmed the diagnosis by revealing specific signs of dissection. The patient was managed conservatively with antiplatelet therapy and other supportive measures, such as blood pressure control and pain management. After 5 mo of rehabilitation, the patient showed significant improvement in swallowing and limb strength.</p><p><strong>Conclusion: </strong>HR-MRI can provide precise evidence for the identification of VAD.</p>\",\"PeriodicalId\":23819,\"journal\":{\"name\":\"World journal of radiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2024-10-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11525835/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World journal of radiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4329/wjr.v16.i10.593\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World journal of radiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4329/wjr.v16.i10.593","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
背景:椎动脉夹层(VAD)是一种罕见但危及生命的疾病,其特征是椎动脉内膜层撕裂,导致狭窄、闭塞或破裂。VAD 的临床表现多种多样,常见症状包括头痛、头晕和平衡问题。及时诊断和治疗是获得良好疗效的关键;然而,由于 VAD 的临床表现多变,且缺乏强有力的诊断指南,因此常常被漏诊。高分辨率磁共振成像(HRMRI)已成为 VAD 的可靠诊断工具,可提供血管壁异常的详细图像。病例摘要:一名年轻男性患者因剧烈头痛、呕吐和癫痫发作急性发病,随后出现意识改变。影像学检查发现双侧 VAD、基底动脉血栓形成、多发性脑干和小脑梗塞以及蛛网膜下腔出血。数字减影血管造影术(DSA)显示椎动脉狭窄,但未能发现夹层,这可能是因为壁内血栓遮挡了VAD。与此相反,HRMRI 通过显示夹层的特殊体征而确诊。患者接受了抗血小板治疗和其他支持性措施(如控制血压和止痛)的保守治疗。经过 5 个月的康复治疗,患者的吞咽功能和肢体力量有了显著改善:结论:HR-MRI 可为识别 VAD 提供精确证据。
High-resolution magnetic resonance imaging in the diagnosis and management of vertebral artery dissection: A case report.
Background: Vertebral artery dissection (VAD) is a rare but life-threatening condition characterized by tearing of the intimal layer of the vertebral artery, leading to stenosis, occlusion or rupture. The clinical presentation of VAD can be heterogeneous, with common symptoms including headache, dizziness and balance problems. Timely diagnosis and treatment are crucial for favorable outcomes; however, VAD is often missed due to its variable clinical presentation and lack of robust diagnostic guidelines. High-resolution magnetic resonance imaging (HRMRI) has emerged as a reliable diagnostic tool for VAD, providing detailed visualization of vessel wall abnormalities.
Case summary: A young male patient presented with an acute onset of severe headache, vomiting, and seizures, followed by altered consciousness. Imaging studies revealed bilateral VAD, basilar artery thrombosis, multiple brainstem and cerebellar infarcts, and subarachnoid hemorrhage. Digital subtraction angiography (DSA) revealed vertebral artery stenosis but failed to detect the dissection, potentially because intramural thrombosis obscured the VAD. In contrast, HRMRI confirmed the diagnosis by revealing specific signs of dissection. The patient was managed conservatively with antiplatelet therapy and other supportive measures, such as blood pressure control and pain management. After 5 mo of rehabilitation, the patient showed significant improvement in swallowing and limb strength.
Conclusion: HR-MRI can provide precise evidence for the identification of VAD.