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Rare Case of Spontaneous Basilar Artery Dissection
EP34256
Poster Title: Rare Case of Spontaneous Basilar Artery Dissection
Submitted on 27 Oct 2020
Author(s): Dr Abdi, Mohammed Hussein; Dr Alex, Joseph; Dr Hassan, Hussein Dr Pai, Deepak
Affiliations: Daina Princess of Wales Hospital, North Lincolnshire and Goole Foundation Trust
This poster was presented at BIR Annual Congress 2020
Poster Views: 317
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Poster Information
Abstract: Introduction:
Spontaneous vertebral artery dissections are rare and can lead to possibly life-threatening complications, such as haemorrhagic strokes. Though accounting for less than 2% of all ischaemic cerebrovascular events, they are more prevalent in the young [1]. Basilar artery dissections are much rarer with an incidence of 1 - 1.5 per 100,000 [2].

Case study:
42-year-old female, with no history of trauma, who presented with left arm paraesthesia, right leg weakness and slurred speech. On examination she had no focal neurological deficits. Liver function tests, thyroid function tests, bone and coagulation profiles were unremarkable. CT head was done to rule out a cerebral vascular accident, which reported possible demyelination and a possible striatal lacunar infarct. After discharge, she was reviewed in the neurology clinic and MS was deemed unlikely. She had multiple further admissions with similar presentations and was eventually diagnosed with a basilar artery dissection after MRI found a basilar artery filling defect

Discussion:
Basilar artery dissections disturb the blood supply to the brain and usually results in brainstem or cerebellar ischaemic strokes. The majority of posterior circulation dissections which involve the basilar artery are through a progression of a vertebral artery dissection and are rarely solitary [3]. Vertebrobasilar dissections are associated with sudden neck movements such as chiropractic adjustments and trauma [4]. In this patient there was no history of trauma nor connective tissue disease. Basilar artery dissections should be an integral differential to rule out in all posterior circulation infarcts, especially in younger patients.
Summary: We report a case of a spontaneous basilar artery dissection causing a stroke. References: 1.Redekop GJ. Extracranial Carotid and Vertebral Artery Dissection: A Review. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 2008;35(2):146-152. doi:10.1017/s0317167100008556
2.Kim BM, Suh SH, Park SI, et al. Management and Clinical Outcome of Acute Basilar Artery Dissection. American Journal of Neuroradiology. 2008;29(10):1937-1941. doi:10.3174/ajnr.a1243
3.Mokri B, Houser OW, Sandok BA, Piepgras DG. Spontaneous dissections of the vertebral arteries. Neurology. 1988;38(6):880-880. doi:10.1212/wnl.38.6.880
4.Haldeman S, Kohlbeck FJ, McGregor M. Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation. Spine. 1999;24(8):785-794. doi:10.1097/00007632-199904150-00010
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