title: Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review.
abstract: Arterial dissection is a rare complication of pregnancy and puerperium. There have been reports of aortic, coronary and cervical artery dissection in association with preeclampsia, however, vertebral artery dissection is rarely reported particularly in the antenatal setting in the presence of a Hypertensive Disorder of Pregnancy (HDP).The general annual incidence of symptomatic spontaneous cervicocephalic arterial dissection is 0.0026 % and a data registry reported that 2.4 % of these occurred in the post-partum period. The actual incidence of vertebral artery dissection in HDP is unknown as the current literature consists of case series and reports only with most documenting adverse outcomes. Given the presence of collateral circulation, unilateral vertebral artery dissections may go unrecognised and may be more common than suspected.
  
  
  
  We present a case series of four patients with vertebral artery dissection in association with HDP, two of which occurred in the antenatal setting and two in the post-partum setting. All our patients had favourable outcome with no maternal neurological deficit and live infants. Our discussion covers the proposed pathophysiology of vertebral artery dissection in HDP and the management of it.
  
  
  
  Our case series highlights the need to consider VAD an important differential diagnosis when assessing pregnant women with headache and neck pain particularly in the context of HDP.
authors.affiliation: Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia. renuka@hypercube3.com.|Western Sydney University, Penrith, Australia. renuka@hypercube3.com.|Vascular Immunology Research Group, Heart Research Institute, Newtown, Sydney, Australia. renuka@hypercube3.com.
authors.forename: Renuka
authors.initials: R
authors.lastname: Shanmugalingam
authors.affiliation: Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia.
authors.forename: Nina
authors.initials: N
authors.lastname: Reza Pour
authors.affiliation: Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia.
authors.forename: Siang Chye
authors.initials: SC
authors.lastname: Chuah
authors.affiliation: Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia.
authors.forename: Thi Mong
authors.initials: TM
authors.lastname: Vo
authors.affiliation: Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia.
authors.forename: Roy
authors.initials: R
authors.lastname: Beran
authors.affiliation: Campbelltown Hospital, Therry Road, Campbelltown, 2560, NSW, Australia.|Western Sydney University, Penrith, Australia.|Vascular Immunology Research Group, Heart Research Institute, Newtown, Sydney, Australia.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Hennessy
authors.affiliation: Liverpool Hospital, Elizabeth Street, Liverpool, 2170, NSW, Australia.|Western Sydney University, Penrith, Australia.|University of New South Wales, Sydney, Australia.|Vascular Immunology Research Group, Heart Research Institute, Newtown, Sydney, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Makris
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001794:Blood Pressure; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D015994:Incidence; D018810:Magnetic Resonance Angiography; D019547:Neck Pain / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D049590:Postpartum Period; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology*; D020217:Vertebral Artery Dissection / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Cerebrovascular accident; Hypertension; Hypertensive disorders of pregnancy; Vertebral artery dissection