Aim(s): Neck arteries dissection (carotid and vertebral) is known as one of the causes of stroke which often occurs after a neck trauma. This study was a case report of a vertebral artery dissection in a young woman following a neck manipulation in order to treat a headache by a local therapist. Patient Information: The patient was a 27 years old woman with migraine headaches who referred to the emergency department with decreased consciousness. The results of metabolic and infectious examinations were negative, therefore brain imaging of the patient was considered. Initial CT scan had no particular finding. Therefore, MRI was performed which indicated acute infarction in the pons and cerebellum. MR angiography was performed to examine the vascular system of the brain which determined the left vertebral artery occlusion. CT angiography recognized vertebral artery dissection as the cause of vascular occlusion. Detailed examination of the patient's condition revealed that the patient experienced the neck manipulation by a local therapist before referral to the hospital. Conclusion: Neck arteries dissection as one of the causes of neurologic deficit and decrease the level of consciousness should be considered in patients with minor or severe trauma. After this diagnosis, the existence of trauma in the patient examination should be considered. Trauma may have a legal significance.

Introduction: Vertebral artery dissection (VAD) is a rare, but life-threatening condition. Compared to the general population, pregnant and postpartum women are more likely to develop VAD. Spontaneous arterial dissections have an ambiguous pathophysiology and may be difficult to manage. This study aimed to pool and analyze the data of published cases in this regard. Methods: We conducted a literature search on February 24, 2022, using MeSH terms of interest in PubMed, Google Scholar, Ovid, Web of Science, and Scopus databases to find studies on VAD following childbirth. Results: A total of 28 studies were included in this review based on a database search. In the studies, 44 postpartum VAD (PPVAD) patients with a mean age of 34. 26 ±,3. 5 years were included. It took an average of 24. 37±,13. 7 days from delivery to dissection. 64% of the patients had developed unilateral dissection and 36% had developed bilateral dissection,70% reported full recovery, and 9% did not achieve full recovery. The most common symptoms were headaches (89%), neck pain (64%), and hypertension (52%). The most common methods of diagnosis were magnetic resonance imaging (MRI) (64%) and computed tomography (CT) angiography (CTA) scan (66%). Only 8 (18%) cases reported the use of electrocardiography (ECG). The recorded outcomes of the patients with unilateral and bilateral postpartum VAD showed no statistical difference. Most of the included studies recommend early suspension and management for a better prognosis and prevention of complications. Conclusion: PPVAD is a severe medical condition but most cases were fully recovered after an early and proper antithrombotic plan for each case scenario.

Dissection of the vertebral artery is an important but rare cause of cerebrovascular accidents. Here we report a 48-year-old man with toothache since 4 days before who presented to the emergency department with neck pain and final diagnosis of dissecting right vertebral artery pseudoaneurysm. To our knowledge, this maybe the first report of odontogenic pain as the first manifestation of vertebral artery pseudoaneurysm in the literatures.

Introduction & Background: True aneurysms of extra cranial vertebral arteries are rare. The usual pathogenesis of aneurysms in this location is either penetrating or blunt trauma with resultant pseudo- aneurysm formation. We report a patient with a presumed pseudo-aneurysm of the extra- cranial vertebral artery presenting with painful neck mass, without obvious history of trauma. Case description: A 59-year old man presented with painful left lateral neck mass from 3 month ago with a bruit over it on physical examination. Patient had a history of long term anticoagulant therapy because of chronic lower extremity DVT. Patient was referred to our DSA (Department for angiography). After color Doppler US, CT scan and MR-angiography were performed and a giant aneurysm in left vertebral artery was detected. The lesion was successfully treated by an endovascular technique of balloon occlusion of the verte-bral artery. 

Background & Aim: The natural course of unruptured vertebral artery dissecting aneurysms (VADAs) remains unclear. The purpose of this retrospective study was to develop a strategy for treating unruptured VADAs based on a long-term follow-up.Methods & Materials/Patients: Our study population consisted of 100 patients with unruptured VADAs; in 66 patients, the initial symptom was only headache, 30 patients presented with ischemic symptoms, and 4 patients presented with mass effect. All patients underwent magnetic resonance imaging and magnetic resonance angiography at the time of admission, and at the intervals of 2 weeks and 1, 3, 6, 12, and 24 months. If the dissection site was demonstrated to be enlarged on magnetic resonance imaging and magnetic resonance angiography without the manifestation of new symptoms, the patients received additional treatment to prevent bleeding.Results: Of the 30 patients, 4 underwent early intervention because of symptom exacerbation. The other 96 were initially treated conservatively; during the follow-up, 5 manifested lesion enlargement on magnetic resonance angiography. Nine patients received additional treatment; 1 underwent direct surgery with the trapping of the dissection site, and 8 underwent coil embolization. The other patients continued to be treated conservatively; the dissection length remained unchanged in 22, improved or healed in 5 patients, and disappeared in 1 patients. We treated patients with recurrent ischemic attacks with antiplatelet therapy. None of the patients experienced bleeding or permanent neurological deficits during the follow-up.Conclusion: The nature of an unruptured VADA is not highly aggressive. However, if the dissection site enlarges without the manifestation of new symptoms, it should be occluded. In patients with recurrent ischemic attacks, antiplatelet therapy should be considered.