A 64 year-old man was admitted to the Komonji Hospital with neck pain and vertigo following a fall from a motor bicycle. On admission he complained of continuous neck pain and then 3 days later, he suddenly complained of vertigo and left hemimotor disturbance. He then slowly developed dysphagia while the his consciousness level tended downward. CT scans repeated 4 days after admission, revealed hydrocephalus induced by left cerebellar infarcts. Anteroposterior and lateral angiograms revealed bilateral vertebral arteries to be occluded at the 5th cervical vertebral level. The patient underwent surgical exploration of the left vertebral artery which was shown to have a subintimal dissection of its cervical portion extending from the transverse foramen of C-6 to c-4. The arterial lumen was occluded with organized thrombus. A common carotid to vertebral artery bypass procedure was performed using a reversed saphena vein graft. The patient's dysphagia cleared and his motor disturbance improved. Postoperative angiogram 2 weeks after surgery revealed good patency of the intracranial basilar artery and the oppo site vertebral artery.
Successful therapy of vertebral artery dissections has been severely limited by failure to recognize the problem. We believe that agressive surgical management of vertebral artery lesions, especially when flow in the contralateral vessel is reduced by hypoplasia, occlusion or stenosis should be performed.
