Spontaneous dissection of the vertebral artery: report of three cases

Vertebral artery dissection (VAD), although uncommon, is an important cause of ischemic stroke in young adults. Without prompt diagnosis and treatment, it may cause mortality and morbidity. Spontaneous VAD related to abrupt neck position change, sudden sneezing, or severe cough and vomiting after fish bone choking are rarely reported. This report describes three cases of spontaneous VAD due to seemingly harmless events.The first patient developed vertebro-basilar ischemic symptoms after suddenly turning his head to the left during an argument with a colleague. The second suffered from right lateral medullary infarction after sudden sneezing. The third developed left lateral medullary syndrome after she tried to extract a fish bone in her throat, which induced severe cough and vomiting. The three cases all presented with acute severe neck pain with posterior circulation ischemic symptoms and signs. Magnetic resonance imaging (MRI), magnetic resonance angiogram (MRA), and conventional angiography confirmed the diagnosis. The first patient was treated with warfarin and recovered well. The other two cases received heparinization and then oral anticoagulant therapy, and recovered without residual neurologic deficits.In conclusion, VAD should be among the differentials considered when encountering young patients presentation with such clinical symptoms.