title: Spontaneous vertebral artery dissection initially mimicking myocardial infarction.
abstract: OBJECTIVE
  Vertebral and carotid artery dissections may present with very different signs and symptoms, making early recognition difficult. However, diagnosis should be established as soon as possible to prevent unnecessary diagnostic investigations and to institute adequate treatment.
  
  
  METHODS
  A 46-year-old man presented with severe intermittent pain of his left upper arm and general discomfort. During extensive cardiological evaluation for suspected myocardial infarction, a severe brain stem syndrome occurred. Ultrasound Doppler studies detected vertebral artery dissection, which was confirmed by angiography.
  
  
  CONCLUSIONS
  The unusual initial presentation of vertebral artery dissection delayed an early diagnosis and adequate treatment. Because noninvasive methods are available today, their applications are recommended in similarly uncharacteristic circumstances.
authors.affiliation: Department of Neurology, University of Heidelberg, Mannheim, FRG.
authors.forename: D
authors.initials: D
authors.lastname: Linden
authors.forename: W
authors.initials: W
authors.lastname: Steinke
authors.forename: A
authors.initials: A
authors.lastname: Schwartz
authors.forename: M
authors.initials: M
authors.lastname: Hennerici
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography; D014711:Vertebral Artery / Q000000981:diagnostic imaging