Vertebral arterial dissection in a young patient, case report

Introduction: Cervical artery dissection accounts for 1–2% of all ischemic strokes and is a common cause of stroke in young people, in which it represents 10–25%. Some studies have reported an increased risk of stroke in patients who present with a dissection, with most occurring soon after the onset of symptoms. Objectives: To report a case of Vertebral Arterial Dissection in a young patient after Direct Trauma, treated at the Hospital Geral de Goiânia. Methods: Information was obtained through clinical follow-up in a Neurology ward and outpatient clinic. Results: Patient, female, 45 years old, reports direct trauma in the right cervical, frontal and left occipital regions. After one day, he suddenly presented right hemiparesis, right peripheral facial paresis, diplopia, vertigo and nausea, dysarthria. On examination, right horizontal gaze palsy, diplopia, right peripheral facial paresis, right curtain sign, tongue deviation to the left. Complete hemiparesis provided grade 3 on the right, tetrasegmental hyperreflexia, Trommer, Hoffman and Babinski on the right. Evidenced on Brain Magnetic Resonance Imaging recent ischemia in the base and pontine tegment lower right and higher left. Cervical Magnetic Resonance Angiography with signs of dissection of segment V3 of the Right Vertebral Artery. Antiplatelets therapy was proposed, evolving with good recovery of the deficits. Conclusion: The literature shows that patients with arterial dissection have head or neck pain, stroke and Horner’s syndrome. Vertebral artery dissection is believed to be a multifactorial process, intrinsic factors present in the setting of an exacerbating extrinsic factor (low-speed car accident, direct trauma, heavy lifting, or a rotational sports injury). As for therapy, more research is needed, there is no evidence of superiority of anticoagulation or antiplatelets therapy.