Vertebral artery dissection: what is it?

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Vertebral artery dissection is tearing the wall of a vessel that carries blood to the brain. It can occur in either branch of these neck arteries following trauma or it can arise spontaneously as a result of connective tissue disease. When the vessel wall is torn, blood pools inside the artery and begins to clot. This process can block part of the blood supply to the brain, resulting in various neurological problems. Given prompt treatment, patients often make a full recovery.

The two vertebral arteries branch out from the lower neck and up along the vertebrae in the skull. In the brain, they merge into the basilar artery, through which they eventually supply blood to areas such as the cerebellar arteries. Dissection refers to the sudden tearing of the vertebral vessel wall. This leads to bleeding within the artery and subsequent pooling of blood in a contained region of the blood vessel. Vertebral artery dissection appears slightly more common in men than in women, although clinical studies disagree on the extent of gender differences.

Vertebral artery dissection can occur after trauma to the neck from force or sudden movement, or it can arise spontaneously from various diseases. Traumatic causes commonly include whiplash injuries from automobile collisions, but extreme neck extension during exercise or chiropractic treatment can also result in lacerations. As with complications from dissection of the neck’s other major blood vessel, the carotid arteries, symptoms include classic neurological difficulties such as pain in the head or neck, dizziness, and visual impairment.

The pathology of a vertebral artery dissection results from hemorrhaging within the blood vessel. The main complication is caused by clotting contained in a portion of the artery, where the blood accumulates in a bag-like compartment. Major dissections can block off a branch of the artery once it clots, cutting off blood supply to parts of the brainstem or cerebellum. Sometimes blood can pool inside the vessel, causing it to expand in a way that resembles an aneurysm, and risk rupture, although this is a rare occurrence.

A small percentage of stroke cases are caused by vertebral artery dissection. Although uncommon overall and among the elderly, this condition accounts for up to a quarter of strokes in young people. Once the blood within the dissecting artery clots, there is a risk that a small piece of the clot will break off into the bloodstream, causing an embolism by blocking a smaller vessel further upstream in the brain. Vertebral artery dissection can be treated with the anticoagulant drugs heparin or warfarin for several months. Most patients recover within a few months of treatment, and deaths are relatively rare.

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