Abstract
Vertebral artery dissection may cause upper limb peripheral motor deficit. We report three young patients presenting with nuchal pain followed by a nearly painless proximal paresis of the arm several days later. The cause, as detected by colour-coded Duplex sonography and MRI, was an extracranial dissection of the vertebral artery. The proximity of the intervertebral segment to the vertebral artery and the nerve roots indicated that compression by an intramural haematoma was the likely cause of the disorder. Subsequent examinations during anticoagulation treatment showed almost complete disappearance of the intramural haematoma and of the neurological deficits within a few weeks. We believe that the occurrence of an upper limb peripheral motor deficit should be added to the spectrum of potentially misleading signs of vertebral artery dissection.
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Bui LN, Brant-Zawadzki M, Verghese P, Gillan G (1993) Magnetic resonance angiography of cervicocranial dissection. Stroke 24:126–131
Catala M, Rancurel G, Koskas F, Martin-Delassalle E, Kieffer E (1993) Ischemic stroke due to spontaneous extracranial vertebral giant aneurysm. Cerebrovasc Dis 3:322–326
Culebras A, Hodge CJ, Petro GR (1989) Carotid and vertebral dissecting hematomas. In: Toole JF (ed) Handbook of clinical neurology, vol. 10 (54): Vascular diseases, part II, Elsevier, Amsterdam, pp 271–285
Dubard T, Pouchet J, Lamy C, Hier D, Caplan LR, Mas JL (1994) Upper limb peripheral motor deficits due to vertebral dissection. Cerebrovasc Dis 4:88–91
Easton JD, Sherman DG (1977) Cervical manipulation and stroke. Stroke 8: 594–597
Friedman DD, Flanders AE (1992) Unusual dissection of the proximal vertebral artery: description of three cases. Am J Neuroradiol 13:283–286
Frumkin LR, Baloh RB (1990) Wallenberg’s syndrome following neck manipulation. Neurology 40:611–615
Garg BP, Ottinger CJ, Smith RR, Fishman MA (1993) Strokes in children due to vertebral artery trauma. Neurology 43:2555–2558
Gelbert F, Assouline E, Hodes JE, Reizine D, Woimant F, George B, Hagueneau M, Merland JJ (1991) MRI in spontaneous dissection of vertebral and carotid arteries. Neuroradiology 33: 111–113
Giroud M, Gras P, Dumas R, Becker F (1993) Spontaneous vertebral artery dissection initially revealed by a pain in one upper arm. Stroke 24:480–481
Hamann G, Felber S, Haass A, Strittmatter M, Kujat C, Schimrigk K, Piepgras U (1993) Cervicocephalic artery dissections due to chiropractic manipulations. Lancet 341:764–765
Hinse P, Thie A, Lachenmayer L (1991) Dissection of the extracranial vertebral artery: report of four cases and review of literature. J Neurol Neurosurg Psychiatry 54:863–869
Hoffmann M, Sacco RL, Chan S, Mohr JP (1993) Noninvasive detection of vertebral artery dissection. Stroke 24: 815–819
Jabre A (1991) Subintimal dissection of the vertebral artery in subluxation of the cervical spine. Neurosurgery 29: 912–915
Linden D, Steinke W, Schwartz A, Hennerici M (1992) Spontaneous vertebral artery dissection initially mimicking myocardial infarction. Stroke 23: 1021–1023
McCormick GF, Van Halbach V (1993) Recurrent ischemic events in two patients with painless vertebral artery dissection. Stroke 24:598–602
Mokri B, Houser OW, Sandok BA, Piepgras DG (1988) Spontaneous dissections of the vertebral arteries. Neurology 38:880–885
Oh VMS (1993) Brain infarction and neck calisthenics. Lancet 342:739–740
Pullicino P (1994) Bilateral distal upper limb amyotrophy and watershed infarcts from vertebral dissection. Stroke 25:1870–1872
Rodacki MA, Mello LR (1990) Bilateral dissecting aneurysms of the extracranial vertebral arteries associated with cervical carotid artery aneurysm. AJNR 11:1147–1149
Ross DA, Olsen WL, Van Halbach V, Rosegay H, Pitts LH (1986) Cervical root compression by a traumatic pseudoaneurysm of the vertebral artery: case report. Neurosurgery 22: 414–417
Six EG, Stringer WL, Cowley AR, Davis CH (1981) Posttraumatic bilateral vertebral artery occlusion. J Neurosurg 58:814–817
Sturzenegger M, Mattle H, Rivoir A, Rihs F, Schmid C (1993) Ultrasound findings in spontaneous extracranial vertebral artery dissection. Stroke 24: 1910–1921
Youl BD, Coutellier A, Dubois B, Leger JM, Bousser MG (1990) Three cases of spontaneous extracranial vertebral artery dissection. Stroke 21: 618–625
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Hetzel, A., Berger, W., Schumacher, M. et al. Dissection of the vertebral artery with cervical nerve root lesions. J Neurol 243, 121–125 (1996). https://doi.org/10.1007/BF02444001
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DOI: https://doi.org/10.1007/BF02444001