Abstract Number: Esoc2026a1521 an Unexplained Case of Bilateral Vertebral and Left Internal Carotid Artery Dissection: A Case Report

Abstract Background and aims Dissection of the supra-aortic vessels is an uncommon cause of cerebral ischemia, but it accounts about 20-25% of cases in subjects aged 30-50 years. The predisposing factors are history of trauma, neck manipulation with hyperextension, male gender, smoking, obesity, arterial hypertension, hypercholesterolemia, use of amphetamine and collagenopathies. If not treated promptly, it can lead to severe neurological consequences, increasing disability and mortality. Results 45-year-old woman presented with new-onset pulsating headache, cervicalgia of greater intensity, right-sided lateropulsion and instability in walking. On neurological examination, there was a cautious gait due to the onset of an objective vertiginous syndrome. Brain CT scan showed a postero-lateral left cerebellar convexity hypodensity and a smaller one ipsilateral near the tentorium. The patient was admitted to Stroke Unit where no reperfusion therapies were performed. Brain MRI showed in addition, a possible dissection at the V2-V3 segments of the left vertebral artery and in the right vertebral artery in the V2 segment. Angio CT scan demonstrated vertebral dissections and detected a dissection of the left internal carotid artery. Therapeutically, anticoagulant therapy was initiated with gradual achievement of the target INR (2-3). Considering the absence of acquired risk factors and no typical history for dissection, a genetic complete panel for collagenopathies was tested, resulting negative. Conclusions Cervical artery dissection is an important cause of stroke in young patients. Despite a complete diagnostic approach, including the investigation of vascular and genetic risk factors, it’s important to recognize that in a percentage of patients, a specific cause cannot be identified. Conflict of interest Ilaria De Negri: nothing to disclose. Simone Lorenzut: nothing to disclose. Domenico Maisano: nothing to disclose. Mariarosaria Valente: nothing to disclose. Giovanni Merlino: nothing to disclose.