[A case of vertebrobasilar dissection which was associated with progressing stroke and was successfully treated by intravascular surgery in the acute stage].
A case of vertebrobasilar dissection which deteriorated in the acute stage and was successfully treated by intravascular surgery is described. A 26-year-old male presented with sudden onset of occipitalgia, weakness of the right upper and lower extremities, and speech disturbance. He was transferred to our hospital 3 hours after the onset. On admission, neurological examination showed right hemiparesis including the face and dysarthria. CT of the head showed no definite abnormality and left vertebral angiograms (VAG) revealed only slight wall irregularity of the basilar artery. T2-weighted MR imaging demonstrated an area of high intensity in the left side of the pons. He was treated conservatively under a diagnosis of pontine infarction. On the 8th hospital day, he developed left hemiparesis. T2-weighted MR imaging revealed a new high intensity lesion in the opposite side of the pons. 3D-SPGR images showed double lumen of the left vertebral artery. Angiography showed that the wall irregularity of the basilar artery had become more obvious. These findings strongly suggested a dissection extending from the left vertebral artery to the basilar artery. Progression of the dissection was presumed to have caused the worsening in clinical symptoms, and further progression of the dissection would involve perforators of the basilar artery top and would be fatal. To prevent further progression of the dissection, the left vertebral artery was occluded at the proximal site of the orifice of the dissection with platinum coils after a test occlusion on the same day. Postoperatively, further deterioration of the clinical symptoms ceased. Left VAG on the 33rd postoperative day demonstrated improvement in the wall irregularity of the basilar artery. His clinical symptoms improved markedly and he was ambulatory at discharge and returned to his previous occupation. We emphasize that a progressive vertebrobasilar dissection that causes clinical deterioration in the acute stage can be prevented from progressing further by occlusion at the proximal site of the orifice of the dissection.
Endoh
H
H
Department of Neurosurgery, Yamagata University School of Medicine, Japan.
Kayama
T
T
Endoh
H
H
Akasaka
M
M
Kondo
R
R
Nagahata
M
M
Hosoya
T
T
Yamaguchi
K
K
D000328:Adult; D000784:Aortic Dissection / Q000601:surgery*; D001488:Basilar Artery / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D006801:Humans; D008297:Male; D014656:Vascular Surgical Procedures / Q000379:methods*; D014711:Vertebral Artery / Q000601:surgery*