Neuroradiology

, Volume 39, Issue 5, pp 329–340 | Cite as

MRI and MR angiography of vertebral artery dissection

  • M. Mascalchi
  • M. C. Bianchi
  • S. Mangiafico
  • G. Ferrito
  • M. Puglioli
  • E. Marin
  • S. Mugnai
  • R. Canapicchi
  • N. Quilici
  • D. Inzitari
DIAGNOSTIC NEURORADIOLOGY

Abstract

A review of 4,500 angiograms yielded 11 patients with dissection of the vertebral arteries who had MRI and (in 4 patients) MR angiography (MRA) in the acute phase of stroke. One patient with incidental discovery at arteriography of asymptomatic vertebral artery dissection and two patients with acute strokes with MRI and MRA findings consistent with vertebral artery dissection were included. Dissection occurred after neck trauma or chiropractic manipulation in 4 patients and was spontaneous in 10. Dissection involved the extracranial vertebral artery in 9 patients, the extra-intracranial junction in 1, and the intracranial artery in 4. MRI demonstrated infarcts in the brain stem, cerebellum, thalamus or temporo-occipital regions in 7 patients with extra- or extra-intracranial dissections and a solitary lateral medullary infarct in 4 patients (3 with intracranial and 1 with extra-intracranial dissection). In 2 patients no brain abnormality related to vertebral artery dissection was found and in one MRI did not show subarachnoid haemorrhage revealed by CT. Intramural dissecting haematoma appeared as crescentic or rounded high signal on T1-weighted images in 10 patients examined 3–20 days after the onset of symptoms. The abnormal vessel stood out in the low signal cerebrospinal fluid in intracranial dissections, whereas it was more difficult to detect in extracranial dissections because of the intermediate-to-high signal of the normal perivascular structures and slow flow proximal and distal to the dissection. In two patients examined within 36 h of the onset, mural thickening was of intermediate signal intensity on T1-weighted images and high signal on spin-density and T2-weighted images. MRA showed abrupt stenosis in 2 patients and disappearance of flow signal at and distal to the dissection in 5. Follow-up arteriography, MRI or MRA showed findings consistent with occlusion of the dissected vessel in 6 of 8 patients.

Key words Arteries vertebral Arteries dissection Magnetic resonance imaging Magnetic resonance angiography 

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Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • M. Mascalchi
    • 1
  • M. C. Bianchi
    • 2
  • S. Mangiafico
    • 3
  • G. Ferrito
    • 4
  • M. Puglioli
    • 2
  • E. Marin
    • 5
  • S. Mugnai
    • 6
  • R. Canapicchi
    • 2
  • N. Quilici
    • 4
  • D. Inzitari
    • 6
  1. 1.Ph. D. Cattedra di Radiologia, Università di Pisa, Via Roma 67, I-56126 Pisa, ItalyIT
  2. 2.Servizio di Neuroradiologia, Ospedale S. Chiara, Pisa
  3. 3.Servizio di Neuroradiologia, Ospedale di Careggi, Firenze
  4. 4.Servizio di Neuroradiologia, Ospedali Riuniti, Livorno
  5. 5.Servizio di Radiologia, Ospedale S. M. Nuova, Firenze
  6. 6.Clinica Neurologica, Università di Firenze

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