Left vertebral artery dissection is a rare but serious condition involving a tear in the inner lining of the left vertebral artery, a major blood vessel in the neck. This tear can disrupt blood flow to the brain, potentially leading to severe neurological complications.
Understanding Vertebral Artery Dissection
The vertebral arteries supply blood to the brainstem and cerebellum, areas of the brain that control balance, coordination, and involuntary functions. These arteries run through the bones of the spine in the neck before joining at the base of the skull to form the basilar artery, creating the vertebrobasilar system.
A “dissection” is a tear in the innermost layer (intima) of the artery wall. This tear allows blood to leak into the middle layers, forming a false lumen or intramural hematoma. This accumulation of blood can narrow the artery’s true lumen, reducing blood flow, or lead to blood clot formation. These clots can then travel to the brain, causing an ischemic stroke, or rarely, the dissection can rupture and cause bleeding around the brain (subarachnoid hemorrhage).
Causes and Contributing Factors
Vertebral artery dissections can occur spontaneously or result from traumatic injuries. Minor trauma to the head or neck, such as whiplash from a car accident, sudden neck movements, or certain sports injuries, are recognized causes. Activities like wrestling, yoga involving neck hyperextension, or even forceful coughing or vomiting have been associated with these dissections.
Underlying conditions can also predispose individuals. Connective tissue disorders like Ehlers-Danlos syndrome or Marfan syndrome can weaken artery walls, making them more susceptible to tears. Fibromuscular dysplasia, a condition where artery walls have abnormal cell growth, is another factor. Recent infections, particularly respiratory tract infections, have also been linked to vertebral artery dissection.
Identifying the Symptoms
Symptoms of a left vertebral artery dissection can vary and often appear suddenly, sometimes delayed by days. A common symptom is sudden, severe neck pain, often described as unusual. Headaches, particularly in the back of the head or occipital area, are also frequently reported.
Neurological symptoms can arise due to reduced blood flow to parts of the brain. These may include dizziness, vertigo (a sensation of spinning), and double vision. Difficulties with speech (dysarthria) or swallowing (dysphagia) can occur. Patients might also experience numbness or weakness on one side of the body, or problems with balance and gait instability. Seeking immediate medical attention is advisable if these symptoms emerge.
Diagnosis and Treatment
Diagnosis typically begins with a physical and neurological examination, followed by imaging tests to visualize the artery and confirm dissection. Magnetic Resonance Angiography (MRA) and Computed Tomography Angiography (CTA) are commonly employed non-invasive imaging techniques that can reveal irregularities, narrowing, or thickening of the arterial wall. Conventional angiography, while more invasive, remains a highly detailed method for evaluating vascular integrity and is sometimes used when non-invasive imaging is inconclusive.
Treatment primarily focuses on preventing blood clots and managing symptoms while the artery heals. Anticoagulation therapy, using medications like heparin initially followed by warfarin, aims to prevent clot formation. Antiplatelet therapy, such as aspirin or clopidogrel, offers an alternative by preventing platelets from clumping together. Pain management for associated neck pain and headache is also an important part of care, often involving analgesics. If medical therapy is insufficient or complications arise, endovascular procedures like stenting may be considered to restore blood flow. Surgical intervention is also an option, though less common.
Recovery and Long-Term Considerations
The recovery period for a vertebral artery dissection varies depending on the severity of the dissection and any resulting complications, such as a stroke. Most vertebral artery dissections heal spontaneously over time, often within three to six months, with appropriate medical management. Regular follow-up imaging, typically MRA or CTA, is recommended to monitor the healing process and detect any potential issues.
Patients are advised to avoid activities that involve extreme neck movements or could cause trauma during recovery. While the prognosis is favorable for those who survive the initial event, there is a potential for recurrence, with reported rates around 4% overall and 7% at one year. Maintaining a healthy lifestyle, including managing blood pressure and avoiding smoking, is important for long-term health and to reduce future risks.