A Case of Intracranial Vertebral Artery Dissection Undetected by CT, MRI, and MRA at the Onset of Headache That Caused Subarachnoid Hemorrhage Seven Days Later

OBJECTIVE: We report a patient with normal imaging findings at the onset of preceding headache who developed subarachnoid hemorrhage (SAH) due to intracranial vertebral artery dissection 7 days later. CASE PRESENTATION: A 51-year-old woman with a history of chronic headache visited our emergency outpatient department with a complaint of mild to moderate right nuchal pain. CT, MRA, and MRI (diffusion-weighted image, T2-weighted image, FLAIR, MR cisternography, and basi-parallel anatomical scanning) were normal. Seven days later, she was admitted to our hospital with sudden disturbance of consciousness. CT revealed SAH and CTA demonstrated dilatation of the right vertebral artery (VA). The dilated lesion with an intimal flap on the right VA proximal to the posterior inferior cerebellar artery was confirmed on DSA. The dilated lesion and the proximal VA were occluded endovascularly using coils. The condition of the patient improved gradually, and she was transferred to the rehabilitation hospital on day 45 with a modified Rankin Scale score of 2. CONCLUSION: The clinical course of the presented case, although rare, should be kept in mind in daily clinical practice.