Have you ever felt a tightness in your neck, a headache, or suddenly seeing two things in one eye? While these may seem like simple things, sometimes there can be something more serious behind them. One such condition that we are going to talk about today is ``Vertebral Artery Dissection``.
What is Vertebral Artery Dissection?
Simply put, this is when a major artery in the back of your neck, along your spine, that carries blood to your brain – called the vertebral artery – tears from the inside. Like a piece of cloth tearing, one or more layers of the artery wall can tear. This is actually a rare cause of stroke in younger people , under the age of 45, rather than older people.
So what is this vertebral artery?
Imagine, at the back of your neck, there are two blood vessels that run up your spine. We call them the vertebral arteries. Their main function is to supply clean, oxygenated blood to your brain and spinal cord . It's like a water pipe, but it's more complicated than that.
This artery has three main layers:
- Intima : This is the innermost layer, closest to the blood flow.
- Media : This is the middle layer. It helps the blood flow in one direction.
- Adventitia : This is the outermost layer. It is what gives the blood vessel its shape and strength.
How does this dissection affect your health?
Now imagine, as I said, when the inner layer of the artery tears, blood starts to leak between the two layers called the intima and the media. Then the blood can collect there and swell like a small balloon. This collected blood can get stuck there and form a blood clot . This blood clot can obstruct the blood flow inside the artery, and it can even completely block it. The artery can also swell (dilate).
The most dangerous consequence of this is stroke :
- Ischemic stroke : This happens when the blood clot becomes large enough to completely or partially block the blood supply to the brain. Sometimes, a piece of the clot can break off and travel down the blood supply to the brain and become lodged in a small artery.
- Hemorrhagic stroke : This happens when all three layers of the artery wall tear. Then blood starts leaking out of the artery, instead of into the brain. If this tear goes deep into the brain, blood can leak into the space around the brain – we call it a subarachnoid hemorrhage – or it can bleed into the brain tissue.
Who is more likely to develop vertebral artery dissection?
Some people can develop this condition for no apparent reason. However, if you have certain health conditions, you may be at a slightly higher risk of developing it. See if these things affect you too:
- Smoking : This is something that opens the door to many diseases.
- Certain genetic conditions : For example , cystic medial necrosis , Ehlers-Danlos syndrome , Marfan syndrome , and osteogenesis imperfecta can cause the walls of blood vessels to weaken.
- Fibromuscular dysplasia : This is a condition in which abnormal cells grow in the arteries.
- High blood pressure : High blood pressure, especially in the arteries connecting the lungs and heart (arterial hypertension).
- Polycystic kidney disease : A disease in which cysts form in the kidneys.
- Vasculitis : Inflammation of the blood vessels.
Are there other risk factors?
Yes, absolutely. This dissection can also occur due to certain injuries to the neck. This can especially happen when the neck is in a hyperextended position or when the neck is suddenly moved quickly . Think about things like this:
- Vehicle accidents.
- Some neck treatments, such as chiropractic adjustments and deep tissue neck massage, may be helpful. However, these may not work for everyone, and there are risks.
- To open the mucus by clenching your jaws loudly.
- When doing yoga, the neck is held up and turned for a long time.
- It's like painting a ceiling, working continuously with your neck bent over.
- Cardiopulmonary resuscitation (CPR) is the treatment given in the event of a sudden cardiac arrest.
- Sneezing loudly.
- Vomiting.
- Betting sports (`Wrestling`).
- Heavy weight lifting.
- Anything else that could cause neck injury.
Can stroke also occur due to other arterial dissection?
Yes, when an artery in your neck is torn, we commonly call it a cervical artery dissection . This includes the vertebral arteries we just talked about, as well as the two carotid arteries that run along the front of your neck. If either of these arteries becomes dislocated, it can cut off blood flow to the brain, causing a stroke .
What is the real risk of stroke?
In fact, the overall risk of stroke from vertebral or carotid artery dissection is low . It accounts for about 2% of ischemic strokes . Most ischemic strokes are caused by a condition called atherosclerosis . This is when the walls of the arteries become thick and narrowed due to other risk factors, such as smoking, high blood pressure, high cholesterol, and diabetes.
But here's the important thing: Vertebral artery dissection is a leading cause of stroke in young and middle-aged people. It can cause up to 25%, or one in four, of strokes in this age group.
What are the symptoms of a vertebral artery dissection?
You may not experience any symptoms at first. But if an artery bursts or a blood clot blocks blood flow to the brain, you may experience symptoms of a stroke .
Be aware of these characteristics:
- Ataxia : Loss of balance while walking or standing, inability to perform tasks properly.
- Dizziness.
- Hearing loss.
- Double vision.
- Neck pain (often on one side).
- Severe headache.
- Slurred speech (Dysarthria).
- Vertigo - A feeling of spinning.
How do you find out if you have a vertebral artery dissection?
The best test to find out exactly what's going on is magnetic resonance angiography (MRA) . This combines an MRI scan with a technique called angiography to take very clear pictures of your vertebral arteries. This allows doctors to quickly determine where the dissection is, how severe it is, and how long it's been there.
However, this MRA test is not available everywhere and is not easy to perform. Therefore, doctors often diagnose this condition with a CT scan (`Computed Tomography - CT scan`) or a CT angiography (`CT angiography`) . These are usually among the first tests that are performed when a person comes in.
Sometimes, your doctor may also recommend a conventional angiography . This involves inserting a thin, long tube (catheter) through your wrist or groin, injecting a special dye (contrast dye), and taking X-ray pictures to see how the blood is flowing inside the artery, the extent of the dissection, and the location of the lesion.
How is this treated?
Most of the time, these dissection conditions will heal on their own over time. However, to reduce the risk of blood clots, you may be given blood-thinning medications . These are the first line of treatment. For example, aspirin , other medications (such as Plavix®) , heparin in liquid form, or warfarin tablets.
However, if the dissection has spread deep into the brain, or if you have had a hemorrhagic stroke , it may not be safe to give these blood thinners. Your doctor will recommend other treatments.
What to do if normal treatment is not successful?
If that happens, you may need to have a procedure. These methods are also used for people who have had a hemorrhagic stroke .
The procedures for vertebral artery dissection are as follows:
- Endovascular embolization : As mentioned earlier, thin tubes (catheters) are inserted through the wrist or groin, into the area of the dissection, and either an embolic agent is injected or small metal coils are inserted. The abnormal part of the artery is sealed with this material or the coils. This stops the blood from flowing through it.
- Angioplasty : This also involves using thin tubes (catheters) to go to the site of the dissection and inflating a special balloon to repair the torn part of the artery.
- Intracranial stenting : This also involves inserting a thin tube (catheter) into the area of the dissection and placing a mesh-like metal device (called a stent) inside the artery. This strengthens the artery wall. This is not done for everyone, only for selected patients. Often, doctors perform both angioplasty and stenting together.
- Surgery : For those who are unable to undergo the endovascular procedures mentioned above, surgery may be necessary. During surgery, doctors use small metal clips to close off the abnormal part of the artery.
What is the recovery rate for people with this condition?
Most people recover completely . However, you may still be at risk of developing a similar dissection in the future. But that risk decreases over time.
What is it like to live with a vertebral artery dissection?
Doctors will monitor you closely until you are sure that the incision has healed completely. They will usually order a magnetic resonance angiography (MRA) scan every three to six months. You will also need to continue taking blood thinners during this time. People who are at high risk of having a dissection in the future may need to see their doctors for years to come (`follow-up care`).
What should I not do after a vertebral artery dissection?
You can exercise, but you should stay away from things like:
- Exercises that are performed by placing your body weight on your hands, such as push-ups and pull-ups.
- Lifting weights over 25-30 pounds (about 11-13.5 kg).
- Lifting weights above the head.
- Contact sports.
- Riding on fast-moving rides like roller coasters.
- Having a chiropractor touch your head/neck.
- Massaging the neck vigorously.
- Things like sky diving.
- Other activities that suddenly increase/decrease speed.
- "Plank" position (`Plank position`). (But apart from that, there is no problem in doing yoga or Pilates, as long as it does not put pressure on the neck).
- Avoid any activity that causes the neck to snap back suddenly (whiplash injury), or any activity that causes the neck to continuously extend upward (hyperextension).
Take-Home Message
Vertebral Artery Dissection is a tear in the wall of a blood vessel in the back of your neck. It rarely leads to a stroke . But if it does, prompt treatment (often blood thinners or a procedure) can save your life. Medical treatment and continued medical supervision can help people with this condition avoid complications. So, if you have any of the symptoms mentioned in this article, please seek medical advice immediately. That's the most important thing.
` Vertebral Artery Dissection, stroke, paralysis, neck pain, headache, dizziness, blood vessel rupture
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