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Neurology (Expert Forum)
Vertebral Artery Dissection
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Vertebral Artery Dissection
by Damiel, Jul 14, 2005 12:00AM
Hello,
On June 2, while talking to a co-worker, I felt a "click" in my head, felt suddenly dizzy and slightly numb on the ring of the left side of my face. The dizziness lasted about 30 minutes before clearing. Did not have speech impediments or confusion. Have not had any deficits since.
I went to a neurologist, they did the usual physical tests and found nothing unusual. They scheduled an MRI/MRA. Had this done July 8. On July 11, I received a call early in the morning from a resident letting me know that I should start taking aspirin but did not give me more details. The neurologist called later to explain that the scan showed no clear indications of anything wrong, BUT...
...they "could not confirm and they could not rule out" a possible left vertebral artery dissection. He said it was a "suspicious area." The doctor said I should take aspirin daily for the next three months at which time I would have another MRI/MRA series and a follow-up appointment with a Dr. in the Stroke Center. Have not had any significant recurrences though I sometimes feel "ice cream"-type headaches on my right side since taking the extra-strength aspirin.
I am M/34, have not had serious health issues, cholesterol levels are quite healthy. Only relevant family history involves my father's death in his 50s due to brain tumor.
Questions: Should I be pushing for more clarity in the diagnosis or is this kind of approach common? I am left uneasy with "cannot confirm and cannot rule out" statement and letting me spend 3 months with this insecurity. Should I ask for aspirin/dipyridamole?
Thanks.
On June 2, while talking to a co-worker, I felt a "click" in my head, felt suddenly dizzy and slightly numb on the ring of the left side of my face. The dizziness lasted about 30 minutes before clearing. Did not have speech impediments or confusion. Have not had any deficits since.
I went to a neurologist, they did the usual physical tests and found nothing unusual. They scheduled an MRI/MRA. Had this done July 8. On July 11, I received a call early in the morning from a resident letting me know that I should start taking aspirin but did not give me more details. The neurologist called later to explain that the scan showed no clear indications of anything wrong, BUT...
...they "could not confirm and they could not rule out" a possible left vertebral artery dissection. He said it was a "suspicious area." The doctor said I should take aspirin daily for the next three months at which time I would have another MRI/MRA series and a follow-up appointment with a Dr. in the Stroke Center. Have not had any significant recurrences though I sometimes feel "ice cream"-type headaches on my right side since taking the extra-strength aspirin.
I am M/34, have not had serious health issues, cholesterol levels are quite healthy. Only relevant family history involves my father's death in his 50s due to brain tumor.
Questions: Should I be pushing for more clarity in the diagnosis or is this kind of approach common? I am left uneasy with "cannot confirm and cannot rule out" statement and letting me spend 3 months with this insecurity. Should I ask for aspirin/dipyridamole?
Thanks.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jul 18, 2005 12:00AM
Arterial dissection is a relatively common cause of stroke in young people. While usually occurring in association with trauma/neck twisting/neck chiropracty etc, it has been known to occur spontaneously. That does not prove that the click though was due to tearing of the artery.
An MRI of the neck with FAT SUPPRESSION is used to make the diagnosis - I do not know if this form of MRI was obtained on you. Usually this scan makes the diagnosis clear although in some cases the tear in the artery can only be seen by a dye angiogram. Ask your neurologist if a dye angiogram (like a heart cath only injecting the neck vessels instead of the coronary vessels) would help ni your case. A follow-up MR scan is a good idea especially if the diagnosis was in doubt.
If a dissection is confirmed as present, it usually heals itself over 3 months - the risk for clots forming at the tear site and going to the brain is very low after this. If a dissection is confirmed the standard treatment is blood thinners such as heparin or coumadin for 3 months. If the diagnosis is not clear, and you are well, and already a few weeks out, aspirin would be reasonable, but the diagnosis should continue to be pursued if possible.
aspirin/dipyridamole has roughly the same efficacy as aspirin - slightly better in one trial - but it has more side effects such as bad headaches.
Good luck
An MRI of the neck with FAT SUPPRESSION is used to make the diagnosis - I do not know if this form of MRI was obtained on you. Usually this scan makes the diagnosis clear although in some cases the tear in the artery can only be seen by a dye angiogram. Ask your neurologist if a dye angiogram (like a heart cath only injecting the neck vessels instead of the coronary vessels) would help ni your case. A follow-up MR scan is a good idea especially if the diagnosis was in doubt.
If a dissection is confirmed as present, it usually heals itself over 3 months - the risk for clots forming at the tear site and going to the brain is very low after this. If a dissection is confirmed the standard treatment is blood thinners such as heparin or coumadin for 3 months. If the diagnosis is not clear, and you are well, and already a few weeks out, aspirin would be reasonable, but the diagnosis should continue to be pursued if possible.
aspirin/dipyridamole has roughly the same efficacy as aspirin - slightly better in one trial - but it has more side effects such as bad headaches.
Good luck
