Extracranial Vertebral Artery Dissecting Aneurysm with Snowboarding: A Case Report

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A 32-yr-old active duty woman presented to the emergency room 2 d after snowboarding where she fell multiple times with one particular hard fall on the back of her head, but no loss of consciousness and she continued snowboarding. She presented with a right-sided occipital headache, along with right shoulder and neck pain, intermittent vertigo, and a general ill feeling. She had no significant medical history, and her only medication was a combined oral contraceptive. Physical examination, including a detailed neurologic examination, was normal except for a blood pressure of 154/98 mm Hg. Computerized tomography angiography (CTA) and magnetic resonance imaging (MRI) imaging obtained revealed a right vertebral artery dissecting aneurysm (VADA) in segment V2 measuring 3 mm with focal stenosis (Fig.A–C).
She was admitted for observation under the neurosurgery service and discharged 24 h later. She was placed on 500-mg naprsoyn twice a day, robaxin 500 mg every 6 h as needed, and 325 mg of aspirin daily. She was to follow-up with her primary care provider and have a repeat magnetic resonance angiography (MRA).
At follow-up with her primary care manager (PCM), she stated her pain was worse upright but relieved lying down. No lumbar puncture was performed. She also had elevated blood pressures of 156/100 mm Hg in the right arm and 136/100 mm Hg in the left arm. Her physical examination remained normal. She was started on 25 mg of propranolol and was evaluated for fibromuscular dysplasia with an MRA of her renal arteries, which results reported as normal. Symptoms gradually improved over a 3-wk time span. Propranolol was stopped at this time as her blood pressure normalized.
Follow-up imaging with MRA at 7 wk showed interval improvement and an adequately patent right vertebral artery with minimal luminal irregularity. Final follow-up imaging 3 months later was reported as normal. Her aspirin was stopped at this time.

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