Dados do Trabalho

Título

Stroke due to spontaneous subclavian and vertebral arteries dissection

RESUMO

A 39-year-old woman suddenly presented rotational vertigo, loss of balance with fall from standing height, without head trauma, and intense left temporoparietal pulsatile headache. She used simple analgesics and didn’t search for medical service at that moment. On the next day, due to the continuation of the symptoms, she looked for medical service. She didn’t have previous cervical trauma or physical activity before the installation of the symptoms and she referred that it all started while she was taking a shower. The patient has systemic arterial hypertension, dyslipidemia and diabetes. She didn’t have any smoking or etilism history and in her family there was no history of previous stroke. At the admission she presented incoordination on the left side of her body and an ataxic gait without other findings. The CT showed hypoattenuation on the posterior and inferior cerebellar vermis and on the left cerebellar hemisphere compatible with an acute stroke. The CTA demonstrated a hypodense semicircular formation partially obliterating the flow of contrast on the left subclavian artery determining a stenosis greater than 50% with extension to the ipsilateral vertebral artery. The diagnosis of stroke due to spontaneous subclavian and vertebral arteries dissection was given. The patient was discharged in use of warfarin and returned in consultation with almost full resolution of the symptoms after a few months.
Arterial dissection is when a tear occurs in the inner layer of the artery, causing an intramural hematoma. The stroke due to arterial dissection is a consequence of the embolism originating on the inner layer of the vessel or a consequence of local hemodynamic compromise due to reduction of the lumen of the vessel. The arteries most commonly affected are the cervical and this type of lesion is generally due to traumatic events, surgical positioning or endovascular procedures. However, a spontaneous subclavian arterial dissection causing a stroke is a very rare event, with only a few cases described in medical literature, and can be associated with migraine, pregnancy and use of illegal substances. The incidence is higher in women between 40 and 50 years associated with systemic arterial hypertension.
Although rare, the spontaneous subclavian arterial dissection is a relevant cause of stroke, specially in young adults, thus clinical suspicion is necessary for a proper management of the case. Anyway it has a good prognosis even with conservative therapy.

Palavras Chave

spontaneous subclavian arterial dissection stroke