Subject: Re: Vertebral Artery Dissection?
Forum: The Neurology and Neurosurgery Forum

Topic Area: Stroke

I am a 44-year-old female, until recently in excellent health. In February I caught the flu, which turned into pneumonia (1st time, to my knowledge, Ive ever had it), successfully treated with Augmentin. About 1 week into the treatment, I began to notice a sensation of coldness in my left cheek when I coughed hard.

Two weeks later, I developed left-sided chest pain, and after an embarrassing but reassuring trip to the ER in which EKG and chest x-rays were normal, costochondritis was diagnosed. Ibubrofen took care of the chest pain, but the cold sensation continued, and expanded in the following weeks to include my left upper lip, eye orbit, & ear, the left side of my neck, and the back of my left arm and hand. Sometimes there is a component of low-grade pain traveling from the back of my head down the left side of my neck. Even though the coughing cleared up, the sensation continued to occur, often after I bent forward and straightened up.

Now the cold sensation, which occurs in "waves" lasting about 8-12 seconds, has been joined by constant dull neck pain, uncoordination in my right leg and sometimes arm, and sometimes by an odd sinking feeling, as though gravity were pulling harder for a moment. These waves seems to occur in clusters, often but not always triggered by motion or by positions in which I crane my neck.

The severity and frequency of these "waves" fluctuates from day to day, but does not appear to be getting better.

The neurologist I saw a week ago thought I might have a vertebral artery dissection (VAD). I passed the basic touch-your-nose-type tests, (though of course I had no "waves" during my whirlwind appointment), but there was an abnormal fluctuation in my blood pressure when I changed position. MRIs were ordered; unfortunately my insurance company is slow at approving such tests and my neurologist is unreachable.

In the meantime, all I know about VAD I got from your site. THANK YOU for your invaluable service.

My questions are:

Are these spreading paraesthesias consistent with VAD? How about the fact that they occur in waves rather than being persistently present? How likely is it that other serious conditions, namely aneurysm, tumor, or MS, are causing my symptoms?

It has been more than two months since my symptoms began and they do not seem to be lessening. At what point ought I begin to notice improvement, if this is VAD?

Thank you again for your assistance to all of us who are struggling with baffling and frightening neurological symptoms.

I think it is very ublikely that a fixed anatomical problem like an aneurysm, tumor or dissection is causing these symptoms, the fact that the symptoms come and go does not fit an underlying cause which is cobstantly present.
For the same reason MS is also somewhat unlikely since the MS plaque is present for several days and does not fluctuate from moment to moment.
I do not think VAD is a very likely diagnosis, if this was likely you should have been admitted to hospital and anticoagulated.
This is not a routine outpatient type diagnosis, if there was a real suspicion that this was a possibility you would not be waiting so long for investigation. The fact that this has been happening for two months strongly suggests to me that VAD is not the underlying cause.
I do not have sufficient informastion from this message to come up with an alternative diagnosis but an MRI of the brain and cervical spine would be a good place to start,this would detect other possible causes like a syrinx / cyst in the brainstem or cervical spinal cord.

Follow Ups:

• Vertebral Artery Dissection? Sonya 5/05/1999 (1)
  • Re: Vertebral Artery Dissection? CCF MD mdf 5/06/1999 (0)

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