1. Resident and Fellow Section
Intracranial Vertebral Dissection in a 15-year-old Boy with Sickle Cell Disease
Teaching NeuroImages
Neurology
Resident and Fellow Section
© 2016 American Academy of Neurology

2. Vignette
A 15-year-old boy with sickle cell disease and bilateral internal carotid artery stenosis became unresponsive after sudden onset headache. A head CT scan demonstrated subarachnoid hemorrhage at the medulla (figure).
MRA of the head and neck (figure) identified a right vertebral artery dissection, which was confirmed on conventional angiography.
Siegler, et al.
© 2016 American Academy of Neurology

3. Imaging A B C D Siegler, et al.
A) Head computed tomography at time of presentation. Arrow indicates hyperdense signal surrounding dark spinal cord in subarachnoid space, concerning for subarachnoid hemorrhage. B) Magnetic resonance angiogram of the head and neck 2 years prior to presentation. Arrows indicate bilateral internal carotid stenosis. C) Magnetic resonance angiogram of the head and neck during hospitalization identifying tapered appearance of the V4 segment of the right vertebral artery (arrow), consistent with dissection. Other segments of the vertebral artery are also labeled: V2 or “pars transversaria,” and V3 or the “atlas loop.” D) Digital subtraction angiogram of a right vertebral injection with arrow indicating the luminal narrowing corresponding to the region of dissection.
Siegler,
et al.
© 2016 American Academy of Neurology

4. Teaching NeuroImages: Intracranial Vertebral Dissection in a 15-year-old Boy with Sickle Cell Disease
The V4 segment of the vertebral artery has the lowest risk of dissection compared to other segments.
However, due to its intracranial location, dissection at V4 can cause subarachnoid hemorrhage and mimic aneurysmal rupture.
Arnold A, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, Benninger D, Sturzenegger M, Mattle HP, Baumgartner RW. Vertebral artery dissection: Presenting findings and predictors of outcome. Stroke. 2006; 37:
Siegler, et al.
© 2016 American Academy of Neurology