Vertebral Artery Dissection Associated with Bathing: A Case Report

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VertebralArtery Dissection (VAD) is often associated with trauma or occurs spontaneously, inevitably causing some neurological deficits. We herein report the case of a 49-year-old female patient presented with sudden onset of severe posterior neck pain with occipital headache, vertigo and vomiting when she was bathing. Dissection of the right vertebral artery at the level of V4 segment was confirmed by use of Magnetic Resonance Imaging (MRI) and CT Angiography (CTA), and Digital Subtraction Angiography (DSA). The patient was started with clopidogrel (75mg/d) and low molecular weight heparin calcium injection (Fraxiparine, 0.4ml: 4100AXaIU/bid, subcutaneous injection). Recovery of neurologic function was excellent, and she was discharged after 21 days. However, reexamine CTA showed an abnormal intracranial segment of the right vertebral artery. The patient still continued treatment with Clopidogrel (75mg/d). We suggest that patients with symptoms of neck pain or headache and even disturbances of posterior circulation after manipulation and stretching of the neck, VAD has to be taken into consideration.

Spontaneousdissection of the intracranial vertebral artery is an increasingly recognized cause of stroke. The annual incidence of spontaneous Vertebral Artery Dissection (VAD) is 1-1.5 per 100,000. Usually, a history of drug treatment, generalized convulsive seizure, minor blunt trauma or activity associated with rotation or hyperextension of the neck, such as tooth-brushing, aerobics, yoga, painting of the ceiling and spinal manipulations can cause VAD, and it is generally labeled as spontaneous dissection. The purpose of this case report is to describe a female patient who presented with posterior neck and occipital pain and was undergoing a vertebral artery dissection when she was standing in a shower and washing her hair. The VAD caused embolic complications: pontine and cerebellar infarctions.

A49-year-old female patient presented with sudden onset of severe posterior neck pain with occipital headache, vertigo and vomiting when she was bathing two hours ago. When she was admitted to our department, she appeared tired and distressed. She stated that she had burning, sharp pain worse than she had ever experienced before. She was healthy previously, and denied any head or neck trauma and chiropractic manipulation. She has no personal or family history of systemic illnesses, connective tissue diseases, myocardial infarctions or cerebrovascular insults. On physical examination, her temperature was 37.6⁰C, pulse 72 beats/min, and blood pressure 132/78 mmHg. No remarkable positive signs were detected by the lung, cardiac, and abdominal examinations.