Vertebral Artery Dissection (VAD)
What is vertebral artery dissection (VAD)?
There are two vertebral arteries in the human body, located in the back of the neck near the spine. They, along with the carotid arteries, supply blood to the brain. Vertebral artery dissection (VAD) is a rare condition that occurs when a tear in the artery wall allows blood to leak between the wall’s layers and separate them. VAD usually occurs in patients younger than 45 years old. Some studies suggest that it may affect females more than males. It is one of the most common reasons for stroke in young people. The typical patient experiences severe head pain following a head or neck injury and, after that, develops focal neurologic signs that are usually due to inadequate amounts of blood flow to the brain. Focal signs may not appear right away, however.What are the symptoms of vertebral artery dissection?
Symptoms can develop over a period of hours or days. They include:- Headache
- Neck and face pain
- Numbness
- Impeded and/or double vision
- Hoarseness
- Vertigo
- Nausea and vomiting
- Loss of taste
- Weakness on one side of the body
- Difficulty swallowing
- Loss of equilibrium
- Stroke
What causes vertebral artery dissection?
VAD is often caused by trauma or injury to the head or neck. This can include blunt trauma like a high-speed car accident or a fall. High blood pressure and smoking have also been shown to increase the risk of VAD. VAD starts when a tear in one layer of the artery wall allows blood to leak through and spread between the layers of the wall. As blood collects, it forms a clot that then limits blood flow and results in the symptoms detailed above. Clots that are large enough to completely block the flow of blood can cause a stroke. People with certain diseases are also at a higher risk of developing VAD, especially diseases like fibromuscular dysplasia, vascular Ehlers-Danlos syndrome, atherosclerosis, and Marfan syndrome. VAD in these patients is spontaneous, meaning it occurs without having experienced trauma to the head or neck.How is vertebral artery dissection diagnosed?
Doctors may use several different imaging technologies to see if there is a tear present in the arteries and how well blood is flowing through them. These include:- CTA (computed tomography angiography) scanning
- MRAs (magnetic resonance angiography)
- Four-vessel cerebral angiography
- Vascular duplex scanning
- Transcranial Doppler ultrasonography
What are the treatments for vertebral artery dissection?
VAD treatment includes, but is not limited to:- In the cases where VAD was not diagnosed before stroke occurred, treating the stroke to prevent lasting effects is the primary goal
- Treating any underlying disorder
- Medications like anticoagulants and antiplatelet agents
- Surgery
- Endovascular treatment
