Vertebral Artery Dissection

Vertebral artery dissection affects the posterior circulation, and most often presents as a lateral medullary syndrome due to emboli in the posterior inferior cerebellar artery (Fig 1).

This causes:

  • Ipsilateral facial pain and loss of temperature sensation (spinal trigeminal nucleus – Fig 2)
  • Contralateral pain and loss of temperature sensation from the body (lateral spinothalamic tract after decussation – Fig 3)
  • Dysphagia and dysarthria (nucleus ambiguus – motor fibres of CN IX and X – Fig 4)
  • Ataxia (cerebellar peduncle – Fig 5)
  • Vertigo (vestibular nuclei – Fig 6)

These patients may also have a Horner’s syndrome caused by ischaemia of descending sympathetic fibres (Fig 7).

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Fig 1
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Fig 2
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Fig 3
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Fig 4
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Fig 5
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Fig 6
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Fig 7
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