Young Female with Recurrent Spontaneous Cervical Artery Dissection

Previous neurosonological study demonstrated the value of neurosonology in daily monitoring of the cervical artery dissection. This study showed rate of recurrence of 27 % in unaffected arteries. There are two group of recurrences, early and late. Early spontaneous cervical artery dissection (sCAD) recurrences are not uncommon and usually involve arteries previously unaffected by dissection. They are oligosymptomatic (headache or neck pain) or asymptomatic and might be correlated with a transient arterial disorder. Late sCAD recurrences are rare and can occur at site of previous sCAD and might be indicative of an underlying persistent connective tissue weakness. In this case report we present a 31- year old female patient who presented to emergency room because of headache and pain in the neck which started 3 days before. Initial brain CT scan and CT-angiography were normal. Next day she became disoriented and complained of headache, vertigo, nausea. Magnetic resonance of the brain showed little hematoma in quadrigeminal cistern and left vertebral artery dissection in V2 segment. Initial neurovascular ultrasound (nUS) showed dissection in V2 segment left vertebral artery. Next nUS after five days showed new dissection in V1 and V2 segment in right vertebral artery. Following nUS showed initial regression hematoma in both vertebral arteries. To conclude, early sCAD recurrences are not uncommon and usually involve arteries previously unaffected by dissection. Because of that it is important to daily neurosonology monitoring of the dissection.