Junior call case 13

There is an acute caliber change of the right vertebral artery at the C1 level with complete occlusion distally.

• Always consider dissection for specific scenarios including younger patients with stroke-like symptoms or chiropractic manipulation (not uncommon!).
• Classic site of vertebral artery dissection is around the C1-2 level, where the artery penetrates the dura.
• Dissection puts the patient at risk for distal thromboembolic strokes. This patient had a subsequent MRI showing no right cerebellar infarct. However, radiologist correctly drew attention to the possible mass effect in this region on the CT, which could be correlated clinically by the neurologist and followed-up with an MRI.