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Clinical and Radiologic Data in 22 Patients with VA Dissection

MR Imaging Findings Patient/Age (y)/Sex Risk Factors* Clinical Presentation Site Conventional Angiographic Findings CT Findings Infarction Abnormal Arterial SI MR Angiographic Findings Treatment Clinical Outcome 1/59/M HTN Dizziness Left V4 Focal aneurysmal dilatation Normal None Crescentic high SI on T1W and T2W Focal aneurysmal dilatation Antiplatelet No change 2/51/M HTN Left-sided paresthesia Left V4 Focal aneurysmal dilatation ... None Crescentic high SI on T1W and T2W Focal aneurysmal dilatation, intimal flap on source image Anticoagulant, antiplatelet Improvement 3/43/M Massage Right lateral medullary syndrome Right V4 Focal aneurysmal dilatation with distal stenosis Normal Right lateral medulla Crescentic intermediate-high SI on T1W and T2W ... Anticoagulant Improvement 4/40/F None Headache Right V4 Aneurysm with proximal irregularity SAH, IVH ... ... ... Balloon embolization Improvement 5/58/M None Dizziness Right V4 Focal aneurysmal dilatation ... None Luminal dilatation with crescentic high SI on T1W and T2W ... Coil embolization Improvement 6/43/M HTN Altered mentality Right V4 Fusiform aneurysmal dilatation SAH, IVH ... ... ... Conservative Death 7/55/F Rule out FMD Headache Left V4 Focal aneurysmal dilatation ("string of pearls" appearance at left V2) Normal ... ... ... Balloon and coil embolization Improvement 8/48/F None Headache Left V4 Fusiform aneurysmal dilatation SAH None Crescentic intermediate-high SI on T1W and T2W ... Coil embolization Improvement 9/30/F None Headache Left V4 Large fusiform aneurysm ... None Luminal dilatation with crescentic high SI on T1W and T2W ... Surgical clipping of proximal VA Quadriparesis 10/55/M None Headache Right V4 Fusiform aneurysmal dilatation SAH ... ... ... Coil embolization Death 11/56/F Rule out FMD Vertigo, diplopia Right V2 Left V2-V4 Intimal flap and irregular long stenosis, pseudoaneurysm Intimal flap and irregular long stenosis ... None Nonvisualization of left distal VA Intimal flaps in both V2s, diminished SI of left distal VA Anticoagulant, antiplatelet Improvement 12/51/M Massage Visual blurring, vertigo Left V1 Complete occlusion of proximal V1 with reconstitution at mid-V2 ... Right medial occipitotemporal gyrus Left V1 not included Signal loss in proximal V1 with reconstitution at mid-V2 Anticoagulant Improvement 13/56/M Golf Left-sided weakness, dysarthria Left V1 Complete occlusion of proximal V1 with reconstitution at mid-V2 Normal ... ... ... Anticoagulant Death 14/45/M None Left lateral medullary syndrome Left V2 Tapered occlusion of proximal V2 with reconstitution at mid-V2 Normal Left lateral medulla Left V2 not included ... Anticoagulant Improvement 15/48/F HTN Right lateral medullary syndrome Right V4 Irregular segmental stenosis ... Right lateral medulla, right occipital lobe Crescentic high SI on T1W ... Anticoagulant Improvement 16/41/M HTN, massage Right lateral medullary syndrome Right V3 Abrupt occlusion ... Right lateral medulla Focal high SI on T1W and T2W ... Anticoagulant Improvement 17/37/M None Dizziness, ataxia Left V2 Irregular long stenosis with filling defects, left PICA§  occlusion ... Left cerebellum, left middle cerebellar peduncle Left V2 not included ... antiplatelet Improvement 18/42/M HTN Right lateral medullary syndrome Right V4 Segmental stenosis ... Right lateral medulla None ... Anticoagulant, antiplatelet Improvement 19/43/M Golf Right lateral medullary syndrome Right V4 Focal filling defect Normal Right cerebellum, right medulla Focal high SI on T2W ... Anticoagulant, antiplatelet Improvement 20/42/M None Right medial medullary syndrome Right V4 Tapered occlusion Normal Right medial medulla Round intermediate SI on T1W and T2W ... Anticoagulant Improvement 21/55/M None Ataxia, dysarthria Right V2 Tapered occlusion Normal Both cerebella, right occipital lobe Focal high SI on T1W and T2W ... Anticoagulant Improvement 22/27/F HTN, SLE Ataxia, dysarthria Both V3s Abrupt occlusion of both V3s with proximal stenosis Infarction in both cerebella, brainstem Both cerebella, brainstem Findings not definite ... Anticoagulant, steroid Improvement *FMD = fibromuscular dysplasia, HTN = hypertension, SLE = systemic lupus erythematosus. SI = signal intensity, T1W = T1-weighted images, T2W = T2-weighted images. IVH = intraventricular hemorrhage. § PICA = posterior inferior cerebellar artery.

This Article Abstract Full Text Submit a response Services Email this article to a friend Alert me to new issues of the journal