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A Case of Vertebrobasilar Dissection which was Associated with Progressing Stroke and was Successfully Treated by Intravascular Surgery in the Acute Stage Hirokazu EMDOH 1 , Takamasa KAYAMA 1 , Hiroshi ENDOH 1 , Masahiro AKASAKA 1 , Rei KONDO 2 , Morio NAGAHATA 3 , Takaaki HOSOYA 4 , Kouichi YAMAGUCHI 4 1Department of Neurosurgery, Yamagata University School of Mediclne 2Department of Neurosurgery, Yamagata Saisei Hospital 3Department of Radiology, Yamagata Saisei Hospital 4Department of Radiology, Yamagata University School of Medicine Keyword: vertebrobasilar dissection , acute stage , endovascular surgery , progressing stroke pp.1001-1005
Published Date 1998/11/10
DOI https://doi.org/10.11477/mf.1436901638
  • Abstract
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A case of vertebrobasilar dissection which deteriorated in the acute stage and was successfully treated by intravascular surgery is described. A 26-year-old male presented with sudden onset of occipitalgia, weakness of the right upper and lower extremities, and speech disturbapce. He was transferred to our hos-pital 3 hours after the onset. On admission, neurological examination showed right hemipares is including the face and dysarthria. CT of the head showed no definite ahnormality and left vertebral angiograms (VAG) revealed only slight wall irregularity of the basilar artery. T2-weighted MR imaging demonstrated an area of high intensity in the left side of the pons. He was treated conservatively under a diagnosis of pontine infarction. On the 8th hospital day, he developed left hemiparesis. T2-weighted MR imaging re-vealed a new high intensity lesion in the opposite side of the pons. 3D-SPGR images showed double lumen of the left vertebral artery. Angiography showed thauhe wall irregularity of the basilar artery had become more obvious, These findings strongly suggested a dissection extending from the left vertebral artery to the basilar artery. Progression of the dissection was presumed to have caused the worsening in clinical symptoms, and further progression of the dissection would involve perforators of the vasilar artery top and would be fatal. To prevent further progression of the dissection, the left vertebral artery was occluded at the proximal site of the orifice of the dissection with platinum coils after a test occlusion on the same day. Postoperatively, further deterioration of the clinical symptoms ceased. Left VAG on the 33rd postoperative day demonstrated improvement in the wall irregularity of the basilar artery. His chnical symptoms im-proved markedly and he was ambulatory at discharge and returned to his previous occupation. We empha-size that a progressive vertebrobasilar dissection that causes clinical deterioration in the acute stage can be prevented from progressing further by occlusion at the proximal site of the orifice of the dissection.


Copyright © 1998, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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