Thursday, 18 November 2010

MRCP revision battle 53.2: Vertebral artery dissection

Vertebral artery dissection is an important recognised cause of stroke in patients under 45 years of age.

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

  • CT 
  • 4 vessel angiogram

  • ?neurosurgery
  • anticoagulate if no associated subarachnoid haemorrhage

Now for some intracranial thrombosis...