Clinical features of vertebral artery dissections presenting with isolated headache or neck pain were investigated, and management was clarified. Forty cases that had only pain at the time of onset, showed neither subarachnoid hemorrhage nor cerebral infarction, and were diagnosed as having vertebral artery dissection by angiography were targeted. In the cases accompanied with aneurysmal dilatation, application of surgical treatment was examined. In other cases, the course was observed by MRA. In the first 18 months, 17 cases were examined. Among them, aneurysmal dilatation was found in 4 cases, and they underwent direct surgery. The other 13 cases were observed: 2 cases showed complete occlusion (at 1.5 months and 5 months, respectively), 3 cases showed no change, and 8 cases showed spontaneous improvement. In the course, neither subarachnoid hemorrhage nor cerebral infarction developed. Therefore, in the last 18 months, observation of the course was attempted as much as possible for the cases, including those of aneurysmal dilatation.
In the period, 23 cases were examined, and aneurysmal dilatation expanded in 2 cases (at 2.5 months and 4 months, respectively). The lesion was obstructed by direct surgery in 1 case and by intravascular treatment in the other. Of the remaining 21 cases, 2 showed no changes in the course by MRA and 19 exhibited spontaneous improvement. In the course, neither subarachnoid hemorrhage nor cerebral infarction developed in any case. For the treatment of vertebral artery dissection presenting with only pain, observation of the course by MRA was effective. Changes occurred in the lesions within several months after onset, and spontaneous improvement occurred in many cases.
Therefore, observation of the course is basically sufficient for management. When aneurysmal dilatation is expanded in the course, direct surgery or intravascular treatment is recommended.