Noninvasive detection of vertebral artery dissection.
OBJECTIVE
We sought to identify the use of duplex and transcranial Doppler sonography in the noninvasive diagnosis of vertebral dissection.


METHODS
Ten patients with a diagnosis of symptomatic vertebral artery dissection confirmed by cerebral angiography were retrospectively analyzed.


RESULTS
Computed tomographic scanning and magnetic resonance imaging together delineated lateral medullary or cerebellar infarcts in 7 patients. Angiography documented a total of 21 vertebral artery lesions (16 stenoses and 5 occlusions), with 7 of 10 patients having multiple sites of vertebral artery dissection. Vertebral Doppler was abnormal in 8 of the 10 patients. A high resistance signal in the relevant vertebral artery was found in 6 patients, no flow in a well-imaged vertebral artery in 1, and bilateral retrograde vertebral artery flow in 1 patient. Transcranial Doppler was abnormal in only 2 patients, with reduced pulsatility index in 1 and high resistance vertebral signal in another. A hyperintense intramural signal of the affected vertebral artery by magnetic resonance imaging was documented in 1 patient in whom Doppler sonography was nondiagnostic.


CONCLUSIONS
Vertebral artery dissection can be detected and monitored by noninvasive vertebral Doppler and magnetic resonance imaging in the setting of a clinically suggestive presentation.
Department of Neurology, Columbia Presbyterian Medical Center, New York, NY 10032.
M
M
Hoffmann
R L
RL
Sacco
S
S
Chan
J P
JP
Mohr
D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging*; D002531:Cerebellum / Q000473:pathology; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014711:Vertebral Artery / Q000000981:diagnostic imaging*