A Painful Stroke: Vertebral Artery Occlusion Presenting as Cervical Radiculopathy and Headache
Keywords:
vertebral artery dissection, vertebral artery stenosis, stroke, anterior spinal arteryAbstract
Background and Objectives: Vertebral artery dissection (VAD) is an increasingly recognized etiology of stroke in patients younger than 45 years. Clinical presentation of vertebral dissection can be quite variable, including cerebellar signs, neck pain, brainstem stroke, or occasionally spinal infarctions. We present a case of VAD presenting as cervical radiculopathy.
Summary of Case : A 43 year old man presented to the emergency department with a one day history of headache and nausea without appreciable neurological deficits. He was discharged with a diagnosis of gastroenteritis and treated symptomatically until he returned the next day with radiating arm pain and paresthesia. Neurologic evaluation identified a mild imprecise dermatomal primary sensory loss in his left arm. Head CT identified a left cerebellar infarction. MRI clarified the presence of a cerebellar stroke as well as a notable spinal cord infarction in the anterior spinal artery (ASA) territory. CTA showed occlusion of the left vertebral artery and non visualization of the ASA.
Conclusions: While most stroke patients manifest without pain, in the absence of trauma, acute onset radiculopathic arm pain can rarely be a manifestation of spinal cord infarction from VAD and should be considered when other explanations are elusive or a simultaneous posterior circulation stroke is identified.
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