Vertebral artery dissection is a rare but important cause of stroke, particularly in younger adults. It occurs when a tear forms in the artery wall, allowing blood to leak and create a blockage or clot. Because symptoms can mimic other conditions, early diagnosis is key to preventing serious complications.
What is Vertebral Artery Dissection (VAD)?
Vertebral artery dissection (VAD) is a tear or dissection in the vertebral artery wall that allows blood to enter, forming a blood clot and impeding flow to the brain. This can lead to stroke symptoms, especially in the brainstem or cerebellum. This condition is particularly concerning in younger adults, as it accounts for a higher percentage of ischemic strokes in young adults compared to older adults, since young individuals are more likely to experience trauma or other risk factors that can trigger a VAD.
In this post, we will talk more about vertebral artery dissection so that we can raise awareness, encourage timely medical attention, and offer hope through specialized care.
The vertebral arteries are a pair of major arteries that run through the neck, branching off from the subclavian arteries, and play an important role in supplying blood to the brainstem, cerebellum, and upper spinal cord. When a tear, or dissection develops in the inner lining of a vertebral artery, blood enters the vessel wall layers, blocking blood flow and leading to clots, potentially triggering a stroke.
Causes and Risk Factors
Everyone needs to understand the difference between spontaneous vs. traumatic dissection. The main difference lies in the cause. A traumatic VAD is caused by blunt or penetrating trauma to the head or neck, such as that suffered in motor vehicle accidents, falls, or sports injuries. A spontaneous VAD, on the other hand, is caused by dissection of the vertebral artery without a clear history of trauma. Possible triggers are neck movements, chiropractic manipulation, or underlying vascular or connective tissue disorders like Ehlers-Danlos, Marfan, and high blood pressure. Young and middle-aged adults, athletes, and those with genetic predispositions are among those at risk.
Common Questions About Vertebral Artery Dissection (VAD)
What is a vertebral artery dissection?
A vertebral artery dissection (VAD) occurs when a small tear develops in the inner lining of one of the vertebral arteries, which supply blood to the brain. Blood can enter the artery wall, narrowing the vessel or forming a clot that may reduce blood flow to the brain and increase the risk of stroke.
What are the symptoms of a vertebral artery dissection?
Symptoms often include sudden neck pain, pain at the back of the head, dizziness, vertigo, difficulty walking, double vision, difficulty speaking, numbness or weakness. Some people experience neck pain or headache several days before neurological symptoms develop.
What causes a vertebral artery dissection?
A vertebral artery dissection may occur after minor neck trauma, sudden neck movements, sports injuries or road traffic accidents. However, many cases develop without an obvious trigger. Certain inherited connective tissue disorders and underlying vascular conditions may also increase the risk.
How is vertebral artery dissection diagnosed?
Diagnosis usually involves CT angiography (CTA), MR angiography (MRA), MRI or, in selected cases, cerebral angiography. These imaging tests allow specialists to assess the vertebral arteries, identify the dissection and determine whether there are signs of reduced blood flow or stroke.
Can vertebral artery dissection be treated?
Yes. Treatment depends on the severity of the dissection, your symptoms and whether a stroke has occurred. Many patients are treated with medication to reduce the risk of clot formation, while selected patients with significant vessel narrowing or stroke may benefit from minimally invasive endovascular procedures such as angioplasty, stenting or mechanical thrombectomy when clinically appropriate.
VAD Warning Signs and Symptoms
Be aware of the warning signs and symptoms of vertebral artery dissection.
- Headache or neck pain - often sudden and severe
- Dizziness or vertigo
- Double vision or visual disturbances
- Difficulty speaking, swallowing, or walking
- Numbness, weakness, or unsteadiness
Symptoms can mimic other neurological conditions or migraines, which is why it's often missed.
VAD Diagnosis at a Specialized Stroke Clinic in Singapore
A detailed patient history and neurological exam are vital for the diagnosis of vertebral artery dissection. A combination of clinical evaluation and advanced imaging tests is used, including:
- MRI and MRA angiography
- CT angiography
- Doppler ultrasound (less common for vertebral artery)
- The advantage of having stroke specialists interpret subtle findings
Vertebral Artery Dissection Treatment Options
Interventional approaches are rare but may include endovascular stenting if there's a risk of stroke. If medical therapy isn't effective or if the dissection is causing a stroke, a specialist may consider endovascular procedures. Medical management may include antiplatelets or anticoagulants to prevent a stroke from occurring. A specialist will recommend a personalized care plan based on the dissection's location, severity, and symptoms.
Recovery, Monitoring, and Long-Term Care
Most dissections heal on their own with time and medication, and recovery from a vertebral artery dissection usually involves a combination of things. Ongoing imaging follow-up is often necessary to ensure healing and prevent a stroke. Rehab may be necessary if neurological symptoms occur. A stroke specialist will also discuss certain lifestyle modifications and provide guidance to reduce the risk of recurrence.
Why Specialized Stroke Care Makes a Difference
Everyone should keep in mind that specialized stroke care significantly improves outcomes for vertebral artery dissection by providing a coordinated approach to diagnosis, treatment, and long-term management. Specialists are trained to recognize early signs of rare stroke causes, and provide personalized and comprehensive care from diagnosis to recovery.
When to Seek Immediate Help
Always be familiar on how to spot a stroke quickly with the BE FAST acronym (Balance, Eyes, Face, Arms, Speech, Time) to recognize the possible signs of stroke. BE FAST stands for:
- Balance Loss
- Eyes - sudden loss of vision, double vision, or blurred vision
- Face Drooping
- Arm Weakness
- Speech Difficulty
- Time to Act - call 9-5-5 immediately!
It is important not to dismiss unusual neck pain, dizziness, or headaches, as these could be signs of a stroke and need to be treated immediately by a stroke doctor.
When to Consider a Vascular Specialist Assessment in Singapore
A vertebral artery dissection can be difficult to recognise because early symptoms may resemble a muscle strain, migraine or tension headache. Prompt specialist assessment is important to reduce the risk of stroke and determine the most appropriate treatment.
Consider seeking a specialist assessment if you:
- Develop sudden, persistent neck pain or pain at the back of the head without a clear explanation
- Experience dizziness, vertigo, double vision or difficulty with balance together with neck pain
- Have abnormal findings on CT, CTA, MRI or MRA involving the vertebral arteries
- Have experienced a transient ischaemic attack (TIA) or stroke that may be related to a vertebral artery dissection
- Have a history of connective tissue disorders or previous arterial dissections
- Require follow-up after treatment for a vertebral artery dissection
- Would like a second opinion regarding medical management, endovascular treatment or long-term monitoring
A specialist consultation includes a detailed review of your symptoms, neurological examination and imaging studies to confirm the diagnosis, assess your stroke risk and develop a personalised treatment and follow-up plan.
Seek emergency medical attention immediately if you experience sudden weakness, numbness, difficulty speaking, vision changes, severe dizziness, difficulty walking, loss of coordination or a sudden severe headache. These symptoms may indicate an acute stroke and require immediate emergency treatment.
Contact Our Compassionate Stroke Specialist, Dr. Manish Taneja, of the Supreme Vascular and Interventional Clinic
Please keep in mind that while VAD may be rare, it's treatable, especially when it is caught early. You know your body best, so if something feels "off," trust your instincts and seek specialized care. Reach out to our specialized stroke clinic in Singapore and our stroke specialist, Dr. Manish Taneja, if you're experiencing symptoms or require proper evaluation. We invite you to contact us today.
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Imagine heart attacks where the blood flow to your heart is blocked. Similarly, a stroke occurs when the blood flow to your brain is interrupted becoming a “brain attack”. When blood supply does not reach a certain part, brain cells begin to die. Different types of stroke include ischemic strokes (blockage of blood vessel due to blood clot) or a mini stroke, a TIA (transient ischemic attack), with no permanent damage yet serious. Stroke also occurs when a blood vessel in the brain pops causing bleeding in the brain.
When a stroke occurs, the symptoms of stroke depend on how blood flow to the brain is affected. Individuals at high risk and even higher risk (family history) often have high blood pressure, atrial fibrillation, or another risk factor for stroke, all of which increase the risk of stroke. Disrupted blood flow can even damage the blood vessel in the brain and affect one side of the body. Having a stroke doesn’t mean it has to lead to permanent disabilities. Recognizing the risk factors and early warning signs is essential to reduce the stroke risk, and in some cases, procedures such as carotid endarterectomy may help increase the blood vessel in the brain and restore healthy circulation.
Certain areas of the brain can be affected by stroke and some symptoms of a stroke including difficulty in speaking. Cardiovascular disease, diabetes, and high blood sugar levels can increase the risk of stroke whereas an active lifestyle or controlling high cholesterol reduces the risk. How well do you know stroke? Find tips to prevent and manage stroke, the differences in stroke screening tests, and the newer technology and treatments available. Come in for an easy consultation and further evaluation to work closely with our stroke specialist in Singapore at the Supreme Vascular and Interventional Clinic.
Supreme Vascular and Interventional Stroke Programs
Neurointerventional / Stroke Treatments
The Supreme Vascular and Interventional Clinic is your "go-to" facility for various neurointerventional / stroke conditions and treatments. To arrange an appointment with Dr. Manish Taneja, our stroke specialist, contact us. You can also call us at (+65) 6904 8084 for a consultation.