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Traumatic Dissection of the Vertebral Artery – Value of Sonographic Diagnostics

Introduction Dissection of a cervical artery supplying the brain is a major cause of stroke in young adults. It can occur spontaneously, in connection with an underlying disorder such as fi bromuscular dysplasia, 1 -antitrypsin defi ciency, hypertension, migraine, atherosclerosis, arteritis or Marfan’s disease [1, 2] . More often, it is related to a neck trauma. In the case of a vertebral artery dissection, a vessel wall can be injured through abrupt or continuous neck movements, regardless of visible outward signs of neck trauma. The fi rst clinical symptoms – occipital headache, neck pain and vertigo – can be associated with focal neurological defi cits of varying severity, from transient ischemic attacks up to complete ischemia in the vertebrobasilar territory [3] . Dissection of the vertebral arteries is most accurately diagnosed with conventional digital subtraction angiography (DSA). In recent years, this procedure is being increasingly replaced by noninvasive techniques, such as magnetic resonance imaging (MRI), MR angiography and duplex ultrasonography [4–7] . We describe a traumatic dissection of the left vertebral artery in the distal V2 segment which was initially not recognized using extracranial duplex sonography – although the examination had been carried out with a view to this very possibility.