Spontaneous vertebral artery dissection with thunderclap headache: a case report and review of the literature.

PURPOSE: Vertebral artery dissection (VAD) is an important and under-recognized etiology of stroke in young patients. No clinical symptoms or signs appear to be specific for VAD. This report describes a representative patient and reviews the headache pattern and imaging findings commonly noted in VAD to help with the early diagnosis of VAD.

CASE REPORT: A 44-year-old female presented with severe right posterior neck pain and vertigo followed closely by thunderclap headache that was confirmed as right VAD (V4 segment) with delayed right dorsal medullary infarction two days later. Her headache, vertigo, and truncal ataxia were completely improved one week later.

CONCLUSION: The most common neuroimaging findings of VAD were vertebral artery stenosis, followed by the string and pearls sign, arterial dilation, arterial occlusion, and the less common but most characteristic features of pseudoaneurysm formation, double lumen, and intimal flap. Pain in VAD mostly occurred in the ipsilateral posterior occipitonuchal region, with throbbing features in 50- 60% of the patients. Only one fifth of patients with VAD present with a thunderclap pattern. In stroke among young patients or stroke with pain in the head and neck, angiography study of the craniocervical artery is highly recommended.