Vertebral Artery Dissection with Subarachnoid Hemorrhage after Brainstem Infarction and de novo Aneurysm of Contralateral Vertebral Artery: Case Report

Abstract

We report a rare case of right vertebral artery dissection. A 45-year-old man suffered numbness, vertigo and occipitalgia due to brain stem infarcton. The right vertebral artery angiograms showed pearl and string signs, indicating vertebral artery dissection. He became comatose suddenly 12 days after ischemic attack. CT scans demonstrated subarachnoid hemorrhage. The second angiograms showed right vertebral occlusion and de novo aneurysm in the left vertebral artery. The patient was treated with mild hypothermic therapy. The third angiograms showed a slight recanalization of the right vertebral artery dissection, and an enlargement of the de novo aneurysm.
We embolized the right vertebral artery dissection using GDC and FPC, and then clipped the aneurysm in the left vertebral artery. The patient was discharged without neurological deficit. We discuss the clinical features and the management of this case.