Atraumatic Vertebral Artery Dissection in a Patient With a Migraine Headache
Abstract
This case discusses a 34-year-old active duty male who presented to the emergency department with a 2-week persistent headache. His initial review of symptoms was reassuring until a detailed neurologic examination on his second visit revealed a visual deficit in the left upper quadrant. Additionally, he complained of intermittent tension headaches for the last several years but had no history of diagnosed migraines until he was seen 4 days prior for empiric migraine therapy in the same emergency department and left without improvement in symptoms. On his return visit, computerized tomography scan with intravenous contrast revealed a left vertebral artery dissection and hematoma. The patient was admitted for medical management and subsequently found to have suffered a small infarction of right lingual gyrus cortex on magnetic resonance imaging. This case illustrates the importance of maintaining a broad differential diagnosis and high index of suspicion in the patient with new focal neurologic findings in order to diagnose a potentially fatal disease.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Apr 20, 2021
- Source ID
- 10.1093/milmed/usab135
Entities
People
- Michael L Lloyd
- Richard Slama
- Samuel Billingslea
Organizations
- Naval Medical Center Portsmouth
- Pacific Northwest University of Health Sciences
- United States Department of Defense