The vertebral arteries themselves arise from the subclavian and join at the base of the medulla oblongata to form the basilar artery.
Presentation of vertebral artery dissection tends to be:
- several occipital headache
- cerebellar signs
- brainstem signs
- CN IX, X, XI and XII:
- dysarthria
- dysphagia
- hiccups
- loss of sensation to ipilateral face
- ipsilateral Horner's syndrome in 1/3 of patients
- 'crossed signs':
- ipisilateral cranial nerve palsy with contralateral hemiparesis or hemiplegia
Causes include:
- trauma
- stretching of neck
- in MRCP questions look for trips to hairdresser, painting ceiling etc
- connective tissue disorders
Investigation:
- CT
- 4 vessel angiogram
Treatment:
- ?neurosurgery
- anticoagulate if no associated subarachnoid haemorrhage
Now for some intracranial thrombosis...
