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Vertebral artery dissection

Case contributed by Mathieu Deltomme
Diagnosis certain

Presentation

Neck and head pain, vertigo, loss of hearing on the right side. Horizontal nystagmus.

Patient Data

Age: 45 years old
Gender: Male

Contrast study

ct

Thickened wall of the right vertebral artery, caused by mural thrombus: dissection. This is also called the suboccipital rind sign. 

No enhancement in the distal intracranial part of the right vertebral artery and dense artery sign on the non-contrast CT. 

Non-contrast CT of the brain

ct

Dense artery sign of the V4 segment of the right vertebral artery. 

Case Discussion

This case show a dissection of the V3-V4 segment of the vertebral artery on non-contrast CT and CT angiography. 

A hyperdense occluded vertebral artery and mural thrombus (thickened wall - suboccipital rind sign) are both pathognomonic CT-signs of vertebral artery dissection. 

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