Combined thrombolysis in posterior circulation stroke caused by bilateral vertebral artery dissection in squash player

Abstract

Background and purpose

Growing number of vertebral artery dissection has been detected due to higher awareness and improved imaging techniques, even after seemingly minor head turning in young- or middle-aged adults without predisposing risk factors for cerebrovascular disease. Treatment options for this condition at this time are limited and there is a troubling shortage of controlled studies.

Summary of case

Our patient suffered a bilateral vertebral artery dissection complicated by posterior circulation stroke. We decided to treat acute stroke with intravenous thrombolytic therapy. Patient's condition worsened despite the treatment so emergency angiography was performed to assess the arterial patency. Additional dose of recombinant tissue plasminogen activator together with mechanical thrombectomy was administered using intraarterial route. The patient recovered well and at 12-month follow-up visit he had only right marginal incomplete hemianopia.

Conclusions

Vertebral artery dissection should be taken into consideration in differential diagnosis of posterior circulation stroke or TIA in young patients with a history of even as subtle precipitating events as forceful head movements. Combined thrombolytic therapy may provide safe and effective treatment of stroke-complicated cases. This case report shows that expanded diagnostic protocol for acute ischemic stroke, including computed tomography perfusion study and angiography of cervical and cranial vessels, assures rapid and correct diagnosis.