SHM Converge Scientific Abstract ePoster Gallery-Vertebral Artery Dissection During Shoulder Exercise: A Case Report

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This case report describes vertebral artery dissection (VAD) in a healthy 18-year-old man after shoulder shrugs at the gym. VAD is a rare but important cause of stroke, especially in younger patients, and may follow even minor trauma. It occurs when blood enters the arterial wall through a tear, leading to thrombus formation, reduced blood flow, embolism, and stroke.<br /><br />The patient presented with 3 days of headache, confusion, projectile vomiting, blurry vision, and gait imbalance. On exam, he had abnormal left-sided coordination testing, but strength, sensation, and reflexes were intact. CT head and MRI brain showed a large evolving acute left cerebellar infarct with obstructive hydrocephalus. CT angiography of the head and neck revealed a left vertebral artery dissection involving the V2 and V3 segments.<br /><br />Neurosurgery recommended no surgical intervention, and the patient was treated with aspirin. Follow-up CT on day 5 showed improvement in the hydrocephalus, and the patient returned to baseline and was discharged on aspirin.<br /><br />The report emphasizes that VAD can present with delayed or nonspecific symptoms such as dizziness, ataxia, dysphagia, diplopia, vertigo, or hearing loss. CT angiography is the preferred diagnostic test, while CT and MRI help identify ischemia, hemorrhage, or thrombosis. First-line treatment is antiplatelet or anticoagulant therapy, with thrombolysis or stenting reserved for select cases.<br /><br />Overall, the case highlights the need to consider vertebral artery dissection in young patients with posterior circulation stroke symptoms after minor neck or shoulder trauma.

Asset Subtitle

Shristi Nepal

Meta Tag

Author List Archana Regmi, Indrani Acosta, Shristi Nepal, Swarnima Rijal

Category Clinical Vignettes

Concept Vertebral Artery Dissection

Concept Ischemic Stroke

Concept CT Angiography

Concept Posterior Circulation Stroke

Concept Computed Tomography Head

Distinguished Non-Finalist

Presenter Organization Hartford Hospital

Presenting Author Shristi Nepal

Track Adult

Keywords

vertebral artery dissection

VAD

cerebellar infarct

posterior circulation stroke

young adult stroke

minor trauma

CT angiography

hydrocephalus

aspirin therapy

gym injury

Vertebral Artery Dissection

Ischemic Stroke

CT Angiography

Posterior Circulation Stroke

Computed Tomography Head