After a neck trauma, a 26-year-old woman developed sudden left headache and vomiting. On admission, she displayed left Horner syndrome with ipsilateral reduced facial sensation to pain and temperature that was crossed in the body, affecting the right limbs. In addition, she had left hemiparesis with dysesthesia in the left hemibody. Proprioception was normal.
Results from laboratory tests, chest radiography, and electrocardiography were normal. Cranial magnetic resonance imaging (Figure 1) showed a large infarct located in the low medulla oblongata and upper cervical cord. Magnetic resonance angiography (Figure 2A) displayed abrupt luminal stenosis of the left proximal vertebral artery and subacute intramural hematoma, suggesting arterial dissection (Figure 2B). The basilar artery was normal. Intravenous heparin sodium was given immediately. During the next 2 weeks, the patient recovered from her weakness almost completely (National Institutes of Health Stroke Scale score of 1). She was discharged on the 15th day with a prescription for oral warfarin sodium.
Sagittal (A) and coronal (B) T2-weighted magnetic resonance images show a large ischemic infarct from the left lateral medulla oblongata to the upper cervical spinal cord (arrows).
Magnetic resonance angiography shows severe luminal stenosis in the left vertebral artery (A) and an axial T1-weighted magnetic resonance image shows wall hematoma in the left vertebral artery (B), suggesting arterial dissection (arrows).
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