Elkady Ahmed, Ghazal Sara, Alanzi Abeer, Madkour Mostafa, Bakheet Majid F
Department of Neurology, Saudi German Hospital, Jeddah, SAU.
Department of Neurology, King Abdullah Medical City, Mecca, SAU.
Cureus. 2020 Jul 14;12(7):e9183. doi: 10.7759/cureus.9183.
Cervicocerebral artery dissection (CAD) is an important and under-recognized cause of strokes in young and middle-aged patients. Spontaneous vertebral artery dissection (VAD) is a rare condition that can potentially cause a stroke without any preceding trauma or other causes of dissection. VAD rarely simulates classical headache syndromes. In this report, we discuss two young patients who were initially misdiagnosed as cases of headache until they presented with ischemic events, and were eventually diagnosed with spontaneous VAD. Case 1 involves a 41-year-old male patient who presented with severe headache radiating to left posterior neck pain and dizziness. He was initially misdiagnosed as a case of cervicogenic headache. He was subsequently diagnosed with extracranial VAD complicated by a delayed embolic ischemic stroke. However, he made full recovery within the next few days. Case 2 pertains to a 33-year-old female patient who presented with right-sided headache mimicking migraine; later on, new neurological signs prompted a diagnosis of acute ischemic infarction as a complication of intracranial VAD. In conclusion, VAD should be seriously considered when dealing with patients complaining of the first attack of headache that mimics migraine or those with cervicogenic headaches, which fail to respond to the usual treatment. Moreover, posterior circulation stroke among young patients or stroke with pain in the head and neck should be investigated carefully with extensive neuroimaging. Finally, prompt and accurate diagnosis of VAD followed by proper treatment is crucial for good outcomes and will prevent disability or even fatal complications in patients.
颈脑动脉夹层（CAD）是中青年患者中风的一个重要但未得到充分认识的病因。自发性椎动脉夹层（VAD）是一种罕见的疾病，可在无任何先前创伤或其他夹层病因的情况下导致中风。VAD很少模拟典型的头痛综合征。在本报告中，我们讨论了两名年轻患者，他们最初被误诊为头痛病例，直到出现缺血性事件，最终被诊断为自发性VAD。病例1涉及一名41岁男性患者，他出现严重头痛并放射至左后颈部疼痛和头晕。他最初被误诊为颈源性头痛。随后他被诊断为颅外VAD并发延迟性栓塞性缺血性中风。然而，他在接下来的几天内完全康复。病例2涉及一名33岁女性患者，她出现类似偏头痛的右侧头痛；后来，新的神经体征促使诊断为急性缺血性梗死，这是颅内VAD的并发症。总之，在处理主诉首次发作类似偏头痛的头痛患者或颈源性头痛且对常规治疗无反应的患者时，应认真考虑VAD。此外，对于年轻患者的后循环中风或伴有头颈部疼痛的中风，应通过广泛的神经影像学检查进行仔细调查。最后，对VAD进行及时准确的诊断并随后进行适当治疗对于取得良好结果至关重要，并且将预防患者出现残疾甚至致命并发症。
