We present the case of a 57-year-old man with headache, numbness, and weakness. We review the differential diagnosis and discuss the relevant imaging. Once the diagnosis is evident, we review the natural history and evidence in support of each possible treatment.
TayKYU-King-ImJMTrivediRA. Imaging the vertebral artery. Eur Radiol. 2005;15(7):1329–1343.
2.
ProvenzaleJMSarikayaB. Comparison of test performance characteristics of MRI, MR angiography, and CT angiography in the diagnosis of carotid and vertebral artery dissection: a review of the medical literature. AJR Am J Roentgenol. 2009;193(4):1167–1174.
3.
VertinskyATSchwartzNEFischbeinNJ. Comparison of multidetector CT angiography and MR imaging of cervical artery dissection. AJNR Am J Neuroradiol. 2008;29(9):1753–1760.
4.
ArauzAMárquezJMArtigasC. Recanalization of vertebral artery dissection. Stroke. 2010;41(4):717–721.
5.
WilkinsonIM. The vertebral artery. Extracranial and intracranial structure. Arch Neurol. 1972;27(5):392–396.
6.
ArauzAHoyosLEspinozaC. Dissection of cervical arteries: long-term follow-up study of 130 consecutive cases. Cerebrovasc Dis. 2006;22(2-3):150–154.
7.
CADISS Trial Investigators; MarkusHSHayterELeviC. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol. 2015;14(4):361–367.
8.
ArnoldMBousserMGFahrniG. Vertebral artery dissection: presenting findings and predictors of outcome. Stroke. 2006;37(10):2499–2503.
9.
TouzeEGauvritJYMoulinT. Risk of stroke and recurrent dissection after a cervical artery dissection: a multicenter study. Neurology. 2003;61(10):1347–1351.
10.
MetsoMMetsoAJHeleniusJ. Prognosis and safety of anticoagulation in intracranial artery dissections in adults. Stroke. 2007;38(6):1837–1842.
11.
EngelterSTRutgersMPHatzF. Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke. 2009;40(12):3772–3776.
12.
PhamMHRahmeRJArnaoutO. Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery. 2011;68(4):856–866; discussion 866.
13.
BifflWLRayCEJrMooreEE. Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg. 2002;235(5):699–706; discussion 706-707.
14.
CothrenCCMooreEEBifflWL. Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate. Arch Surg. 2004;139(5):540–545; discussion 545-546.
15.
EdwardsNMFabianTCClaridgeJA. Antithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from long-term follow-up. J Am Coll Surg. 2007;204(5):1007–1013; discussion 1014-1015.
