NONINVASIVE DETECTION OF VERTEBRAL ARTERY DISSECTION

Background and Purpose: We sought to identify the use of duplex and tr anscranial Doppler sonography in the noninvasive diagnosis of vertebra l dissection. Methods: Ten patients with a diagnosis of symptomatic ve rtebral artery dissection confirmed by cerebral angiography were retro spectively analyzed. Results: Computed tomographic scanning and magnet ic resonance imaging together delineated lateral medullary or cerebell ar infarcts in 7 patients. Angiography documented a total of 21 verteb ral artery lesions (16 stenoses and 5 occlusions), with 7 of 10 patien ts having multiple sites of vertebral artery dissection. Vertebral Dop pler was abnormal in 8 of the 10 patients. A high resistance signal in the relevant vertebral artery was found in 6 patients, no flow in a w ell-imaged vertebral artery in 1, and bilateral retrograde vertebral a rtery flow in 1 patient. Transcranial Doppler was abnormal in only 2 p atients, with reduced pulsatility index in 1 and high resistance verte bral signal in another. A hyperintense intramural signal of the affect ed vertebral artery by magnetic resonance imaging was documented in 1 patient in whom Doppler sonography was nondiagnostic. Conclusions: Ver tebral artery dissection can be detected and monitored by noninvasive vertebral Doppler and magnetic resonance imaging in the setting of a c linically suggestive presentation.