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Format: 04/17/2014
Format: 04/17/2014

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WSOC-TV, Charlotte: Surviving Vertebral Dissection

Tuesday, October 27th, 2009

Vertebral Dissection and Stroke

The vertebral arteries are a pair of arteries running from the neck area of the spine to the bottom of the skull. Inside the skull, the two arteries join together to form the basilar artery, the main artery feeding the brainstem.

An injury to the neck (even a minor one) can lead to a tear, or dissection, in the inner wall of the vertebral artery. The tear can cause the formation of a hematoma (a mass of clotted blood) inside the blood vessel. One of four things can then happen: 1. The hematoma seals and causes no further problems. 2. The mass of clotted blood expands and partially or completely blocks the artery. 3. Clots form, which can travel through the bloodstream, becoming trapped in smaller arteries of the brain. 4. The tear expands through the entire thickness of the arterial wall, causing blood to leak out of the broken vessel.

If blood flow through the vertebral artery is disrupted, part of the brain is deprived of oxygenated blood and may die (a stroke). A stroke may also occur if blood clots from the dissection travel further beyond the site and block the flow of blood elsewhere in the brain.

Vertebral artery dissections are relatively rare. However, researchers say the condition accounts for about 20 percent of strokes seen in younger (30 to 45) patients. Women are affected about three times more often than men.

Most patients complain of headache or neck pain. Other signs may include dizziness, nausea, weakness and/or double vision. In many cases, the symptoms occur after minor neck injury. Signs of stroke may not occur for three days after the onset of neck pain. In a few cases, symptoms have been reported after chiropractic manipulation in the neck area. However, researchers say there is no hard evidence to link spinal manipulation to stroke.

Dealing with Vertebral Artery Dissection

Researchers estimate about 10 percent of patients with a vertebral artery dissection die soon after the injury. If a younger person comes into the emergency room with a complaint of neck pain or headache and signs suggestive of an impending or ongoing stroke, prompt treatment needs to be started. An important clue to the diagnosis is neck trauma or forceful pressure on the neck sometime before the onset of symptoms.

Brad Bellotte, M.D., Neurosurgeon with Allegheny General Hospital in Pittsburgh, says pressure from the swelling hematoma can cause further brain damage. So the initial treatment involves relieving the pressure on the brain. A section of the skull bone over the base of the brain is removed and the covering over the brain is opened. Then, a small patch is sewn over the opening to protect the brain tissue. This allows the brain to swell without adding extra pressure on other areas of the brain. Peak swelling usually occurs within three to five days, during which the patient is monitored closely.

Vascular Neurologist, Ashis Tayal, M.D., says patients are placed on blood thinners for about six weeks to reduce the risk of more clots. After that they are usually on long-term anti-platelet medication.

To read more, visit the WSOC-TV web site.

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