title: Vertebrobasilar dissections: case series comparing patients with and without dissecting aneurysms.
abstract: Vertebrobasilar dissections are being increasingly diagnosed due to better awareness and increased availability of modern imaging techniques of the intracranial and extracranial arteries. The clinical presentation and outcome in patients with vertebrobasilar dissections may be complicated by dissecting aneurysms. The aim of this retrospective study was to compare the clinical profile of patients with vertebrobasilar dissections with and without dissecting aneurysms, and to determine predisposing factors to the development of aneurysms. Thirty patients (19 [63%] male; median age 44.5 years) were identified. The patients were divided into two groups, an aneurysmal dissection group with seven patients and a non-aneurysmal dissection group with 23 patients. Eight (27%) patients presented with dissection after trivial trauma, three (10%) following high-speed vehicular trauma, two (7%) were associated with infection, but most (57%) were apparently spontaneous. Migraine with aura (p=0.008) and female sex (p=0.03) were observed more frequently in the aneurysmal dissection group. Though vascular risk factors other than hypertension and atrial fibrillation were seen in a greater percentage of patients in the non-aneurysmal dissection group, this was not statistically significant. Patients were treated with antiplatelet agents (n=8) or warfarin (n=13) or underwent an endovascular intervention (n=6). Post-discharge data were available in 19 patients, of whom 14 (74%) were independent at a median follow-up of 4 months. Female sex and migraine with aura may predispose to the formation of acute dissecting aneurysms and this requires further research. Larger, prospective studies are required to ascertain epidemiologic and etiologic factors predisposing patients to the development of both intracranial and extracranial dissecting aneurysms in the vertebrobasilar circulation.
authors.affiliation: Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Gold Coast University Hospital, Level 5, A-Block, 1 Hospital Boulevard, Southport, QLD 4215, Australia. Electronic address: monicabadve@gmail.com.
authors.forename: Monica S
authors.initials: MS
authors.lastname: Badve
authors.affiliation: Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Henderson
authors.affiliation: Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: John D
authors.initials: JD
authors.lastname: O'Sullivan
authors.affiliation: Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Wong
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors.forename: Ken
authors.initials: K
authors.lastname: Mitchell
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, QLD, Australia; Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
authors.forename: Alan
authors.initials: A
authors.lastname: Coulthard
authors.affiliation: Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Read
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis* / Q000628:therapy*; D001281:Atrial Fibrillation / Q000150:complications; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000150:complications; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Dissecting aneurysm; Dissection; Vascular risk factors