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Vertebral artery dissection (VAD) usually presents with posterior headache or neck pain followed within hours or days by posterior circulation stroke. We describe a patient with acute lateral medullary infarction 2 months after investigations for neck pain, which was subsequently identified as VAD.
Case report.
A man aged 38 years was admitted after awakening with left-sided headache, right facial numbness, altered taste over the right side of his tongue, diplopia in all directions of gaze, vertigo, unsteadiness, and difficulty swallowing. Examination disclosed bilaterally restricted eye abduction, reduction in conjugate elevation, reduced pinprick sensation over the right cheek, midline ataxia, and a right extensor plantar.
Diffusion-weighted MRI performed the day after presentation demonstrated an acute left lateral medullary infarct (figure, A), and T1-weighted MRI with fat suppression demonstrated an intramural hematoma of the left vertebral artery, confirming the clinical suspicion of VAD (figure, …
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