![]() Bilateral VAD may be fatal due to the potential compromise of the posterior cerebral circulation.Įarly diagnosis is crucial to achieve better outcomes, especially when the presentation is vague or asymptomatic. According to Schievink, bilateral VAD accounts for 10 to 25% of all causes of ischemic stroke in young patients. The incidence of vertebral artery dissection is estimated to be 2.6–3/100 000. The internal carotid artery is most commonly affected, but occasionally, other arteries can be involved as well. Although uncommon in the general population, it is a recognized cause of ischemic stroke in younger patients. IntroductionĬervical artery dissection presents at any age, with a wide range of symptoms. The patient did not report any bleeding complications from dual therapy. MR angiography after three months revealed complete resolution of the dissection. She was discharged home with no complications and followed up with neurology as an outpatient. The patient was initiated on warfarin, along with atorvastatin and aspirin. Cerebral arteriography confirmed the diagnosis of VADs. CT angiography was concerning for VADs, and MRI brain revealed multiple strokes in the left posterior inferior cerebellar artery (PICA) territory. She denied any trauma but admitted to multiple roller coaster rides over the past few months. A 37-year-old healthy female presented to the emergency department with worsening neck pain and headache for two weeks despite over-the-counter medication, block therapy, yoga, and deep tissue neck massage. We report a case of spontaneous bilateral vertebral artery dissections (VADs) treated with both anticoagulation and antiplatelet therapy and a literature review on clinical presentation and the current medical and surgical management options. Medical management with either anticoagulation or antiplatelet therapy is recommended, but there are no reports of successful dual therapy. The largely nonspecific symptoms and delayed presentation pose a serious diagnostic challenge. Vertebral artery dissection (VAD) is a rare cause of ischemic stroke in young patients. ![]()
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