Vertebral Artery Dissection

Vertebral artery dissection is a serious condition where a tear occurs in the wall of one of the vertebral arteries, which are major blood vessels in your neck supplying blood to your brain. Blood can then leak into this tear, forming a clot that narrows or blocks the artery. This can lead to a stroke, especially in younger individuals.

What is Vertebral Artery Dissection?

Vertebral artery dissection happens when the inner lining of a vertebral artery, a key blood vessel in your neck that carries blood to your brain, develops a tear. This tear allows blood to collect within the artery wall, forming a clot. This clot can then narrow the artery, reduce blood flow, or send smaller clots to the brain, potentially causing a stroke.

Your body has two vertebral arteries, one on each side of your neck. They join together at the base of your brain to form the basilar artery, which supplies blood to important brain structures. When a dissection occurs, the blood trapped within the artery wall can create a bulge or block the normal flow of blood. This reduced blood flow can deprive parts of your brain of oxygen and nutrients. Vertebral artery dissection is a significant cause of stroke, particularly in people under the age of 45. While it can be a serious event, early diagnosis and treatment are crucial to prevent or minimize complications. The condition can sometimes occur spontaneously, meaning without a clear cause, or it can be linked to certain injuries or underlying health issues.

Symptoms

Symptoms of vertebral artery dissection often appear suddenly and can include severe headache and neck pain, especially at the back of the head or on one side of the neck. Other common signs relate to reduced blood flow to the brain, such as dizziness, vision changes, problems with speech or balance, and weakness on one side of the body.

The most common symptoms are a sudden, severe headache, often described as a thunderclap headache, and neck pain. This pain is frequently located at the back of the head or on one side of the neck. These symptoms can sometimes appear hours or even days after the initial tear in the artery. Other symptoms are often signs of a stroke or reduced blood flow to the brain. These may include dizziness (vertigo), double vision, difficulty speaking (dysarthria), trouble swallowing (dysphagia), problems with balance or coordination, and numbness or weakness on one side of your body. Some people might also experience a drooping eyelid (Horner's syndrome) or ringing in their ears (tinnitus). It is important to remember that these symptoms can vary in intensity and may not all be present. If you experience any of these signs, especially if they come on suddenly, seek immediate medical attention.

Causes & risk factors

Vertebral artery dissection can sometimes occur without a clear cause, known as spontaneous dissection. However, it is often linked to trauma, such as neck injuries from accidents, sports, or sudden head movements. Certain underlying health conditions and lifestyle factors can also increase your risk of developing this condition.

Trauma to the neck is a common cause. This can include injuries from car accidents (like whiplash), sports injuries, or even sudden, forceful movements of the head or neck. In some cases, chiropractic neck manipulation has been associated with vertebral artery dissection. Several risk factors can make you more susceptible to a dissection. These include certain connective tissue disorders, such as Ehlers-Danlos syndrome or Marfan syndrome, which affect the strength and elasticity of blood vessel walls. Fibromuscular dysplasia, a condition that causes abnormal cell growth in artery walls, is also a risk factor. Other factors that can increase your risk include high blood pressure (hypertension), smoking, a history of migraines, and the use of oral contraceptives. While these factors increase risk, many dissections still occur in people without any obvious predisposing conditions.

How it's diagnosed

Diagnosing vertebral artery dissection typically involves a physical examination, including a neurological assessment, followed by specialized imaging tests. These tests allow doctors to visualize the blood vessels in your neck and brain, helping them identify tears, clots, or blockages within the vertebral arteries.

During a physical exam, your doctor will check your neurological function, looking for signs like weakness, changes in reflexes, or problems with balance and coordination. This initial assessment helps guide further diagnostic steps. Imaging tests are crucial for confirming a diagnosis. Common methods include computed tomography angiography (CTA) and magnetic resonance angiography (MRA). These non-invasive tests use X-rays or magnetic fields, respectively, along with a special dye, to create detailed images of your blood vessels. In some cases, a conventional angiography (catheter angiography) may be performed. This is a more invasive procedure where a thin tube (catheter) is inserted into a blood vessel, usually in the groin, and guided to the vertebral arteries. A dye is then injected, and X-ray images are taken to provide very detailed views of the artery's condition.

Treatment options

Treatment for vertebral artery dissection primarily focuses on preventing stroke and promoting healing of the artery. This usually involves medications to prevent blood clots, such as blood thinners or antiplatelet drugs. In rare cases, if medication is not effective or if there is a high risk of stroke, surgical or endovascular procedures may be considered.

The most common treatment involves medications to prevent blood clots. Your doctor may prescribe anticoagulants (blood thinners), such as heparin or warfarin, to stop existing clots from growing and prevent new ones from forming. Another option is antiplatelet drugs, such as aspirin, which help prevent blood cells called platelets from sticking together and forming clots. Both anticoagulants and antiplatelets are considered safe and effective for treating vertebral artery dissection, and your doctor will decide which is best for your specific situation. These medications are typically taken for several months while the artery heals. For severe cases, or if medication alone does not prevent stroke or if there is persistent narrowing of the artery, more invasive procedures might be necessary. These can include endovascular procedures, such as placing a stent to open the narrowed artery, or, rarely, surgery to repair the artery directly.

Recovery & outlook

Many people who experience a vertebral artery dissection recover fully, especially with prompt and appropriate treatment. The outlook generally depends on the severity of the initial dissection and whether a stroke occurred. Some individuals may experience lasting neurological problems, but recurrence of the dissection is uncommon.

The healing process for a dissected vertebral artery can take several months. During this time, it's important to follow your doctor's instructions regarding medication and follow-up appointments. Regular monitoring, often with repeat imaging tests, helps ensure the artery is healing properly and to assess blood flow. While many individuals make a complete recovery, some may experience long-term neurological problems if a stroke occurred. These can include persistent weakness, speech difficulties, or problems with balance. Rehabilitation therapies, such as physical therapy, occupational therapy, and speech therapy, can help manage these challenges and improve function. Recurrence of vertebral artery dissection is rare, but it is important to discuss any ongoing symptoms or concerns with your healthcare provider. Maintaining a healthy lifestyle and managing any underlying risk factors, such as high blood pressure, can also contribute to a positive long-term outlook.

When to see a doctor

You should seek immediate medical attention if you experience sudden and severe symptoms that could indicate a vertebral artery dissection or a stroke. These emergency signs include a sudden, severe headache, neck pain, dizziness, changes in vision, difficulty speaking, or weakness or numbness on one side of your body.

These symptoms are medical emergencies and require immediate evaluation. Do not wait to see if they improve. Calling 911 or your local emergency services is crucial, as prompt diagnosis and treatment can significantly improve outcomes and reduce the risk of permanent damage from a stroke. Even if the symptoms seem to resolve quickly, it is still important to be checked by a doctor. A transient ischemic attack (TIA), sometimes called a mini-stroke, can have similar symptoms that pass quickly but are a warning sign of a potential future stroke. Early intervention is key to preventing more serious complications. If you have a known risk factor for vertebral artery dissection, such as a connective tissue disorder or a recent neck injury, and you develop any new or worsening head or neck pain, or neurological symptoms, contact your doctor right away for advice.

Frequently asked questions

Can a vertebral artery dissection heal on its own?

While the tear in the artery wall can often heal over time, it's crucial to receive medical treatment. Medications like blood thinners are typically prescribed to prevent blood clots and reduce the risk of stroke while the artery heals. Without treatment, the risk of serious complications like stroke is much higher.

Is vertebral artery dissection always caused by an injury?

No, vertebral artery dissection is not always caused by an injury. While trauma to the neck, such as whiplash or sudden movements, can be a cause, many cases occur spontaneously without any clear injury. Underlying conditions like connective tissue disorders can also increase the risk.

How long does recovery take after a vertebral artery dissection?

Recovery time can vary widely depending on the individual and whether a stroke occurred. The artery itself typically takes several months to heal. If a stroke did occur, recovery may involve rehabilitation therapies and can take longer, with some individuals experiencing lasting effects.

Can I exercise after a vertebral artery dissection?

After a vertebral artery dissection, your doctor will provide specific guidance on physical activity. Strenuous activities, especially those involving sudden neck movements or heavy lifting, may be restricted initially. It's important to follow your doctor's recommendations to allow the artery to heal and prevent re-injury.

What is the chance of having another vertebral artery dissection?

The chance of having another vertebral artery dissection (recurrence) is generally considered uncommon. However, your doctor will discuss your individual risk factors and may recommend ongoing management or lifestyle changes to help minimize any future risk.

Are there any long-term effects of vertebral artery dissection?

Many people recover fully from vertebral artery dissection. However, if a stroke occurred as a result, there can be long-term neurological effects such as weakness, speech problems, or balance issues. Rehabilitation can help manage these effects, and your doctor will monitor your recovery.

Sources

• MedlinePlus — Vertebral Artery Dissection
• Mayo Clinic — Vertebral Artery Dissection
• Cochrane Library — Vertebral Artery Dissection