Ruptured vertebral artery dissection treated conservatively: a case report

• Published in: Japanese Journal of Stroke Vol. 40; no. 4; pp. 280 - 284
• Main Authors: Nishi, Noriyuki, Yamada, Tomonori, Marutani, Akiko, Miyaza, Shizuka, Takahashi, Daisuke, Kobayashi, Junya, Watanabe, Kotaro, Goda, Toshiaki, Ikegami, Takeshi
• Format: Journal Article
• Language: Japanese; English
• Published: The Japan Stroke Society 2018
• Subjects: bilateral; conservative treatment; subarachnoid hemorrhage; vertebral artery dissection
• ISSN: 0912-0726; 1883-1923
• DOI: 10.3995/jstroke.10548

A 68-year-old man suffered from a severe headache 3 days after receiving a gastrectomy for early gastric cancer. Computed tomography demonstrated subarachnoid hemorrhage. Conventional angiography and magnetic resonance imaging (MRI) revealed bilateral vertebral artery dissections. Surgical management, such as trapping or proximal occlusion, should have been immediately performed, but the ruptured side in the vertebral arteries was unknown, and we were worried about brain ischemic complications after surgical intervention for the bilateral vertebral arteries. Therefore, the patient ultimately underwent conservative treatment. He had a good clinical course and was discharged from our institute 2 months after onset. An annual follow-up MRI showed no evidence of worsening dissection of the bilateral vertebral arteries over 5 years. Considering the difficulty involved in surgical treatments for ruptured vertebral artery dissections, we recommend conservative treatment.