We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Images in Neurology |

A Very Small but Very Symptomatic Vertebral Artery Dissection

Richard P. Goddeau Jr, DO; Louis R. Caplan, MD; David B. Hackney, MD; Adel A. Alhazzani, MD; David Eric Searls, MD
Arch Neurol. 2010;67(2):248-249. doi:10.1001/archneurol.2009.318.
Text Size: A A A
Published online


A 45-year-old man developed sudden vertigo while riding a snowmobile. He attributed his symptoms to a cold, stayed home from work, and did not seek medical care. During the next 3 weeks, he had additional symptoms, including horizontal diplopia, dysarthria, and left arm clumsiness. When he developed left face and arm paresthesias, he came to the emergency department. Neuroimaging revealed chronic left proximal cerebellar and acute bilateral distal cerebellar infarctions (Figure 1), raising suspicion for embolism from the left vertebral artery.1,2 A cardiac source for embolism was not found. A curved reconstruction image from computed tomographic angiography of the neck showed a possible dissection flap in the V3 segment of the left vertebral artery (Figure 2A) that was most apparent on 1.25-mm axial source images (Figure 2B). Anticoagulation was started. On repeated computed tomographic angiography 1 month later, the dissection flap was resolving, but a pseudoaneurysm was apparent (Figure 2C). He had no further cerebrovascular events.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.

Head computed tomography and brain magnetic resonance imaging at presentation. A, Noncontrast computed tomography showing established left proximal cerebellar infarct. B and C, Diffusion-weighted imaging sequence on magnetic resonance imaging showing acute bilateral distal cerebellar infarction.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Computed tomographic angiography of the neck at presentation and at 1 month. At presentation there was subtle nonocclusive filling defect (arrow) of the V3 segment of the left vertebral artery just distal to the foramen transversarium of C2 on the curved reconstruction image (A) and axial source image (B). C, At 1 month, imaging shows healing dissection with apparent pseudoaneurysm (arrow and inset).

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles