Gomez-Rojas Olga, Hafeez Adam, Gandhi Nikhil, Berghea Ramona, Halalau Alexandra
Office of Occupational Health, Alexander von Humboldt Peruvian German School, Lima, Peru.
Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA.
Case Rep Med. 2020 May 25;2020:8180926. doi: 10.1155/2020/8180926. eCollection 2020.
Vertebral artery dissection (VAD) is a rare cause of ischemic stroke in young patients. The largely nonspecific symptoms and delayed presentation pose a serious diagnostic challenge. Medical management with either anticoagulation or antiplatelet therapy is recommended, but there are no reports of successful dual therapy. We report a case of spontaneous bilateral vertebral artery dissections (VADs) treated with both anticoagulation and antiplatelet therapy and a literature review on clinical presentation and the current medical and surgical management options. A 37-year-old healthy female presented to the emergency department with worsening neck pain and headache for two weeks despite over-the-counter medication, block therapy, yoga, and deep tissue neck massage. She denied any trauma but admitted to multiple roller coaster rides over the past few months. CT angiography was concerning for VADs, and MRI brain revealed multiple strokes in the left posterior inferior cerebellar artery (PICA) territory. Cerebral arteriography confirmed the diagnosis of VADs. The patient was initiated on warfarin, along with atorvastatin and aspirin. She was discharged home with no complications and followed up with neurology as an outpatient. MR angiography after three months revealed complete resolution of the dissection. The patient did not report any bleeding complications from dual therapy.
椎动脉夹层（VAD）是年轻患者缺血性卒中的罕见病因。其症状大多不具特异性且出现较晚，给诊断带来了严峻挑战。推荐采用抗凝或抗血小板治疗进行药物管理，但尚无双重治疗成功的报道。我们报告一例采用抗凝和抗血小板联合治疗的自发性双侧椎动脉夹层（VAD）病例，并对临床表现以及当前的药物和手术治疗选择进行文献综述。一名37岁健康女性因颈部疼痛和头痛加重两周就诊于急诊科，尽管服用了非处方药物、进行了阻滞治疗、瑜伽和颈部深层组织按摩。她否认有任何外伤，但承认在过去几个月里多次乘坐过山车。CT血管造影显示可能存在VAD，脑部MRI显示左小脑后下动脉（PICA）区域有多处卒中。脑血管造影确诊为VAD。患者开始服用华法林，同时服用阿托伐他汀和阿司匹林。她出院时无并发症，作为门诊患者接受神经科随访。三个月后的磁共振血管造影显示夹层完全消退。患者未报告双重治疗引起的任何出血并发症。
