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      Vertebral Artery Dissection as a Cause of Cervical Radiculopathy

      case-report

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          Abstract

          The acute onset of neck pain and arm weakness is most commonly due to cervical radiculopathy or inflammatory brachial plexopathy. Rarely, extracranial vertebral artery dissection may cause radiculopathy in the absence of brainstem ischemia. We describe a case of vertebral artery dissection presenting as cervical radiculopathy in a previously healthy 43-year-old woman who presented with proximal left arm weakness and neck pain aggravated by movement. Cervical magnetic resonance imaging (MRI) and angiography revealed dissection of the left vertebral artery with an intramural hematoma compressing the left C5 and C6 nerve roots. Antiplatelet treatment was commenced, and full power returned after 2 months. Recognition of vertebral artery dissection on cervical MRI as a possible cause of cervical radiculopathy is important to avoid interventions within the intervertebral foramen such as surgery or nerve root sleeve injection. Treatment with antithrombotic agents is important to prevent secondary ischemic events.

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          Cervical-artery dissections: predisposing factors, diagnosis, and outcome.

          Stephanie Debette, Didier Leys (2009)
          Cervical-artery dissection (CAD) is a major cause of cerebral ischaemia in young adults and can lead to various clinical symptoms, some of which are benign (eg, headache, neck pain, Horner's syndrome, and cranial-nerve palsy), but most patients have a stroke or transient ischaemic attack. In addition to trauma to the neck, other risk factors have been suggested, such as infection, migraine, hyperhomocysteinaemia, and the 677TT genotype of the 5,10-methylenetetrahydrofolate reductase gene (MTHFR 677TT), although evidence is sparse. An underlying arteriopathy, which could in part be genetically determined, is believed to have a role in the development of CAD. Importantly, both research on and optimum management of CAD strongly rely on diagnostic accuracy. Although the functional outcome of CAD is good in most patients, socioprofessional effects can be important. Incidence of the disorder in the general population is underestimated. Mortality and short-term recurrence rates are low but possibly also underestimated. Further research is warranted to improve our understanding of the underlying pathophysiology, to assess the long-term outcome, and ultimately to provide treatment and prevention strategies.
          Article 0 comments Cited 143 times – based on 0 reviews     Review now
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            Headache and neck pain in spontaneous internal carotid and vertebral artery dissections.

            Simone Schievink, L Silbert, Bahram Mokri (1995)
            We studied the characteristics of headaches in 161 consecutive symptomatic patients with spontaneous dissections of the internal carotid artery (n = 135) or the vertebral artery (n = 26). For patients with internal carotid artery dissection (ICAD), the mean age was 47 years and for those with vertebral artery dissection (VAD), 40.7 years. A history of migraine was present in 18% of the ICAD group and in 23% of the VAD group. Headache was reported by 68% of the patients with ICAD and by 69% of those with VAD, and, when present, it was the initial manifestation in 47% of those with ICAD and in 33% of those with VAD. Ten percent of patients with ICAD had eye, facial, or ear pain without headache. The median interval from onset of headache to development of other neurologic manifestations was 4 days for the ICAD group and 14.5 hours for the VAD group. For all dissections, headaches typically were ipsilateral to the side of dissection. In the ICAD group, headaches were limited to the anterior head in 60% of patients and were steady in 73% and pulsating in 25%. In the VAD group, headaches were distributed posteriorly in 83% of patients and were steady in 56% and pulsating in 44%. Neck pain was present in 26% of patients with ICAD (anterolateral) and in 46% of those with VAD (posterior). The median duration of the headache in patients with VAD and ICAD was 72 hours, but headaches became prolonged, persisting for months to years, in four patients with ICAD.
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              Spinal manifestations of vertebral artery dissection.

              B Mokri, B Crum, J Fulgham (2000)
              Among 111 patients with vertebral artery dissection (VAD), two presented with spinal manifestations: one with a C5-C6 radiculopathy and the other with a cervical myelopathy. Of 13 previously reported cases of spinal manifestations of VAD (mean age 37 years), ischemic cervical myelopathy was noted in seven; cervical radiculopathy, often at C5-C6 and primarily motor, in five; and hemorrhagic complications in one, with chest pain being part of the presentation.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Asian Spine J
                Journal ID (iso-abbrev): Asian Spine J
                Journal ID (publisher-id): ASJ
                Title: Asian Spine Journal
                Publisher: Korean Society of Spine Surgery
                ISSN (Print): 1976-1902
                ISSN (Electronic): 1976-7846
                Publication date (Print): December 2013
                Publication date (Electronic): 28 November 2013
                Volume: 7
                Issue: 4
                Pages: 335-338
                Affiliations
                [1 ]Department of Neurology, Royal Perth Hospital, Perth, Australia.
                [2 ]SKG Radiology, St. John of God Hospital, Perth, Australia.
                [3 ]Perth Neurophysiology, Perth, Australia.
                Author notes
                Corresponding author: Benjamin Isaac Silbert. Department of Neurology, Royal Perth Hospital, Wellington St, Perth WA 6000, Australia. Tel: +61-8-9224-2244, Fax: +61-8-9238-1321, Benjamin.Silbert@ 123456health.wa.gov.au
                Article
                DOI: 10.4184/asj.2013.7.4.335
                PMC ID: 3863660
                PubMed ID: 24353851
                SO-VID: cb4269a6-a666-451b-93c1-01db267e0562
                Copyright © Copyright © 2013 by Korean Society of Spine Surgery
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 10 June 2012
                Date revision received : 19 July 2012
                Date accepted : 13 September 2012
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Orthopedics
                Keywords: radiculopathy,vertebral artery dissection,neck pain,cervical spine
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: radiculopathy, vertebral artery dissection, neck pain, cervical spine

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