Background: Vertebrobasilar dissections are being increasingly diagnosed with the aid of modern neuroimaging techniques.
Aim: To study the clinical and imaging characteristics, treatment and outcome of patients with vertebrobasilar dissections treated at our hospital.
Methods: Patients presenting with vertebrobasilar dissections from October 2002 to January 2009 were identified from Central Medical Records, Neurology and Radiology departmental databases and their medical records and imaging reviewed.
Results: Thirty-two patients (21 (66%) male; mean age 44.2 years) were identified. Twenty-three (72%) patients presented with ischaemic events, 6 (19%) with subarachnoid haemorrhage (SAH), and 3 (9%) with neither on imaging. Two of the 6 patients with subarachnoid haemorrhage also showed ischaemia on imaging. Nine (28%) patients reported ipsilateral headache and neck pain. Nine (28%) patients presented with dissection after trivial trauma (including 3 after chiropractic manipulation), 2 (6%) following high-speed vehicular trauma, 2 (6%) were associated with infection, but most (59%) were apparently spontaneous. At discharge, one patient (3%) had died, but 12 (37.5%) were independent (mRS ( Modified Rankin Scale ≤2). Median follow- up (4 months) was known in 20 patients, of whom 14 (70%) were independent. Patients were prescribed antiplatelet therapy or warfarin or they underwent an endovascular intervention. It is difficult to predict how these interventions affected outcome due to small numbers.
Conclusion: Patients with vertebrobasilar dissection have a generally good outcome despite diverse clinical presentations. Larger trials are required to ascertain the optimal management strategy.