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Vertebral Artery Dissection: Spectrum of Imaging Findings with Emphasis on Angiography and Correlation with Clinical Presentation¹

¹ From the Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-Dong, Songpa-Ku, Seoul 138-736, South Korea. Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received March 2, 2000; revision requested April 5 and received May 15; accepted May 16. Address correspondence to D.C.S. (e-mail: dcsuh@www.amc.seoul.kr).

A study was performed to evaluate the relationship between the imaging features and clinical presentation of vertebral artery (VA) dissection. Twenty-two patients with 24 VA dissections at angiography and clinical evaluation also underwent computed tomography and magnetic resonance imaging. The angiographic patterns of VA dissection were categorized as aneurysmal (n = 10) or steno-occlusive (n = 14). All 10 patients (10 lesions) with the aneurysmal pattern had dissection in the V4 (intradural) segment and presented with headache (n = 5), neurologic deficit (n = 2), dizziness (n = 2), or altered mentality (n = 1). However, the 12 patients (14 lesions) with the steno-occlusive pattern had dissection from the V1 segment to the V4 segment and presented with neurologic deficits caused by infarction of an embolic nature. Overall, the most frequent VA dissection site was the V4 segment. The distribution of the dissection sites and the clinical presentation tended to differ according to the angiographic patterns of aneurysm or stenosis-occlusion.

Index Terms: Angiography, comparative studies, 1751.1243 • Computed tomography (CT), comparative studies, 1751.12116 • Magnetic resonance (MR), comparative studies, 1751.12142 • Magnetic resonance (MR), vascular studies, 1751.12142 • Vertebral arteries, dissection, 1751.74 Vertebral arteries, stenosis or obstruction, 1751.74

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