title: Vertebral artery dissection presented as lateral medullary syndrome in a patient with migraine: a case report.
abstract: OBJECTIVE
  Migraine and artery dissection are both rare causes of ischemic stroke. The mechanism of migraine-related intracranial artery dissection is still unknown. It is proposed that the repeated attack of migraine would make the involved artery more vulnerable to tearing and lead to dissection.
  
  
  METHODS
  We describe a 42-year-old female suffering from basilar-type migraine for more than 20 years. The patient complained severe dizziness with hyperventilation while watching television. Initially anxiety and migraine attack were impressed in the emergency room, but dizziness accompanied with dysarthria and dysphagia was noted later. After admission, lateral medullary syndrome was suspected after a detailed neurological examination, and a brain magnetic resonance image (MRI) revealed an acute infarction on the left lateral medulla oblongata, confirming the clinical diagnosis Furthermore, cerebral angiography revealed the left distal vertebral artery dissection. The patient was reluctant to use an anticoagulant; therefore aspirin was given for secondary stroke prevention and topiramate for migraine prophylaxis.
  
  
  CONCLUSIONS
  The exact mechanism of migraine-related intracranial artery dissection has yet to be proven, we propose that this may be caused by vessel wall edematous changes with repeated migraine attacks resulting in sudden or unusual stretching.
authors.affiliation: Section of Neurology, Department of Internal Medicine Far-Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Ju-Chun
authors.initials: JC
authors.lastname: Yen
authors.forename: Lung
authors.initials: L
authors.lastname: Chan
authors.forename: Yen-Jun
authors.initials: YJ
authors.lastname: Lai
mesh_terms: D000328:Adult; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000150:complications / Q000209:etiology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008526:Medulla Oblongata / Q000000981:diagnostic imaging / Q000473:pathology; D008881:Migraine Disorders / Q000150:complications / Q000209:etiology*; D009460:Neurologic Examination; D020217:Vertebral Artery Dissection / Q000150:complications*