Vertebral artery dissection typically causes an ischaemic brain stem stroke. We report a man who presented with left sided neck pain and Brown-Séquard’s syndrome localised to C1, and in whom a focal C1 ischaemic cord lesion secondary to a localised vertebral artery dissection was found using MRI.

A 47 year old machine operator was admitted as an emergency with neck pain, headache, and gait disturbance. Three weeks before admission he developed minor stiffness of his upper cervical region while decorating his home, which was relieved by ibuprofen. There was no history of neck manipulation or trauma. Two days before admission he awoke with a severe left sided pounding headache and neck ache with an associated cold sensation on the left side of his neck. He was nauseated but did not vomit. His symptoms again resolved within an hour with ibuprofen, but two hours later there followed a tingling sensation in his left index finger, thumb, and forearm spreading up to his elbow. He slept for a few hours but awoke with more generalised paraesthesiae in the left arm which spread over the next 36 hours to involve the left trunk and leg. He noticed minor gait disturbance as well as …