Re: vertebral artery dissection, disease

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Posted by ccfNeuro MD on June 05, 1997 at 16:43:29:

In Reply to: vertebral artery dissection, disease posted by cheryl on May 29, 1997 at 23:07:22:

: Last year I suffered a vertebral artery dissection, aneurysm. I am left with a right vertebral artery that is very, very small. I have daily headaches. Pulsing and pressure in the lower right side of my lower head and neck. also deep ear pain. My recent angiogram showed a branch of new arteries branching off from the injured artery supplying blood to the spinal column. I believe that this is where the extra pressure is coming from. I suffer today from complete loss of appetite and nausea and vomiting weekly. My doctor wants to do more tests looking at the brain stem, and also the cervical MRI to look at the effect of the extra arteries supplying blood to the spine. Let me mention that the insurance company is giving us a hard time. any suggestions? I need some answers. I have also been diagnose and treated with sarcoidosis of the lungs and salivary glands.

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An arterial dissection is basically a tearing of an inner layer of the wall of an artery. This torn inner layer forms a “flap” so to speak. Blood flows underneath this flap in the artery and because of this, the true lumen of the artery becomes smaller and sometimes is even closed off entirely. Blood flow to regions of the brain supplied by the involved artery can be compromised and can cause a stroke. A collection of blood from under this flap can sometimes form an outward bulge called a pseudoaneurysm, which it sounds like you had, as well. Dissections occur most commonly in the carotid arteries, the big arteries that run on each side of the neck in the front, but they can also occur in the vertebral arteries which run in the back of the neck. Dissections are usually due to some sort of trauma to the neck or head, which may be very mild, such as turning or bending the head suddenly. Some dissections occur without any precipitating events. The vertebral arteries supply blood to the back of
the head and the brainstem. The vomiting center is located in the brainstem and it is possible that this part of the brainstem was injured as a result of the dissection. I would expect you to have other symptoms, such as difficulty swallowing, or weakness if this was the case. (The brainstem is an area of "high real estate" because many different important structures lie very near each other. Because of the close proximity, damage to the brainstem rarely causes one isolated symptom.) An MRI of the brainstem, which you are in the process of getting, is a good way to figure this out. Headaches are common in arterial dissections, they usually resolve after several days. The headaches you are experiencing now may be due to the development of the collateral blood supply. Dilatation of collateral vessels, along with the release of various substances by these blood vessels, is thought by some to be one of the causes of headaches after strokes. It is also conceivable that the vessels are putting direct pressure on sensitive structures. The cervical MRI sounds reasonable. You do indeed have a complicated problem. I hope the hassles with the insurance company is worked out. A letter by your physician explaining the situation often is all that is needed. Good luck to you. This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.

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