Bilateral vertebral artery dissections involving the left vertebral artery of aortic origin: A case report

Abstract

A 42-year-old man complained of headache, dizziness, and vomiting. Head magnetic resonance imaging revealed a lack of visualization ranging from the bilateral vertebral artery (VA) to the basilar artery, and the bilateral cerebellum and brainstem infarction. The left VA originated from the aortic arch. The patient followed a stable course with antithrombotic therapy. As the dissected arteries recanalized chronologically, the patient was diagnosed with bilateral VA dissections. To the best of our knowledge, there have been no reports of bilateral VA dissections involving the left VA of aortic origin. The mechanism of bilateral VA dissections was speculated as follows: arterial dissection extends to the contralateral side or flow reduction of the dissected VA increases perfusion of the contralateral VA, thus inducing dissection. In addition, the left VA of aortic origin is at high risk of arterial dissection. Therefore, right VA dissection may induce left VA dissection, especially in cases of aortic origin, and this speculation is compatible with our case.