Bilateral vertebral artery dissection complicated by posterior circulation stroke in a young man: A case report

INTRODUCTION: Vertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. Improved imaging techniques can be used to detect VAD, whose current treatment options are limited. PATIENT CONCERNS: The patient presented with neck and shoulder pain for a week after sleeping against the wall with cervical proneness for 1 night. He had sudden headache, slurred speech, and left side weakness for 1.5 hours on admission. DIAGNOSIS: The patient had VAD complicated by posterior circulation stroke. INTERVENTIONS: Acute stroke was treated with intravenous thrombolytic therapy. Then, the patient was administered follow-up anticoagulants. OUTCOMES: The patient's condition improved after thrombolytic therapy. He recovered well, with no recurrence during a 4-year follow-up. CONCLUSION: VAD should be taken into consideration in differential diagnosis of posterior circulation stroke or transient ischemic attack in young patients. Intravenous thrombolytic therapy may be safe and effective for stroke-complicated cases. This case report demonstrates that expanded diagnostic protocol for acute ischemic stroke assures rapid and correct diagnosis.