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A case of multiple Vertebrobasilar artery fenestration misdiagnosed as vertebral artery dissection.
BMC Neurology ( IF 2.6 ) Pub Date : 2020-02-20 , DOI: 10.1186/s12883-020-01642-2
Feng Wang 1 , Xiaokai Wang 2 , Xiaohua Li 2 , Huifeng Zheng 2 , Zhiyong Zhang 3
Affiliation  

BACKGROUND Fenestration of vertebra-basilar artery is an uncommon congenital vascular anomaly, which is identified by incidental findings on imaging in patients presented without related symptoms or in patients with intracerebral hemorrhage secondary to concomitant artery aneurysm or arteriovenous malformations. Yet, cases of fenestration being misdiagnosed as cerebral artery dissection have never been reported. CASE PRESENTATION We present a patient of 66-year-old female with acute onset of dizziness after chiropractic manipulation of the neck. Neck computed tomography angiography (CTA) showed 'double lumen' sign and 'intimal flap' of the V1 segment of the vertebral artery, which led to the initial diagnosis of vertebral artery dissection (VAD). However, vertebral artery fenestration at V1 segment was eventually identified by multi-directional digital subtraction angiography (DSA). Interestingly, concomitant vertebral fenestration at V3 segment, basilar fenestration and basilar artery tip aneurysm was also revealed by DSA. CONCLUSION The triple fenestration at vertebrobasilar artery with basilar tip artery aneurysm is extremely rare, and the fenestration at the V1 segment of vertebral artery was easily misdiagnosed as VAD due to the similar imaging morphology.

中文翻译:

一例多发椎基底动脉开窗误诊为椎动脉夹层。

背景技术椎基底动脉的穿刺术是一种罕见的先天性血管异常,可以通过在无相关症状的患者或伴随动脉瘤或动静脉畸形继发脑出血的患者中通过影像学的偶然发现来确定。然而,开窗术被误诊为脑动脉夹层的病例尚未见报道。病例介绍我们介绍了一位66岁的女性患者,该患者在脊骨按摩治疗后突然头晕。颈部计算机断层造影血管造影(CTA)显示椎动脉V1段的“双腔”体征和“内膜皮瓣”,从而初步诊断为椎动脉解剖(VAD)。然而,最终通过多方向数字减影血管造影(DSA)确定了V1段椎动脉开窗。有趣的是,DSA还显示了V3段椎体开窗,基底开窗和基底动脉尖端动脉瘤。结论椎基底动脉三重开窗伴基底端动脉瘤极少见,由于相似的成像形态,在椎动脉V1段开窗很容易被误诊为VAD。
更新日期:2020-02-20
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