open access

Vol 48, No 4 (2014)
Case reports
Submitted: 2014-03-17
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Combined thrombolysis in posterior circulation stroke caused by bilateral vertebral artery dissection in squash player

Emilia Frankowska, Krzysztof Brzozowski, Jacek Staszewski, Norbert Kolmaga, Adam Stępień, Romana Bogusławska-Walecka
DOI: 10.1016/j.pjnns.2014.07.010
·
Neurol Neurochir Pol 2014;48(4):299-304.

open access

Vol 48, No 4 (2014)
Case reports
Submitted: 2014-03-17

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.

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.

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Keywords

Dissection, Stroke, Thrombolysis, Interventional neuroradiology, Thrombectomy

About this article
Title

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

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 48, No 4 (2014)

Pages

299-304

DOI

10.1016/j.pjnns.2014.07.010

Bibliographic record

Neurol Neurochir Pol 2014;48(4):299-304.

Keywords

Dissection
Stroke
Thrombolysis
Interventional neuroradiology
Thrombectomy

Authors

Emilia Frankowska
Krzysztof Brzozowski
Jacek Staszewski
Norbert Kolmaga
Adam Stępień
Romana Bogusławska-Walecka

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