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| LETTER TO EDITOR |
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| Year : 2013 | Volume
: 61
| Issue : 2 | Page : 183-184 |
"Target sign" in an intracranial vertebral artery dissection with isolated vertigo
Sushin Park, Hak-Seung Lee, Jin Sung Cheong, Yeon Soo Ha
Department of Neurology, Wonkwang University School of Medicine, Jeonbuk Regional Cardio Cerebrovascular Disease Center, 344-2 Shinyong-dong, Iksan, South Korea
| Date of Submission | 18-Mar-2013 |
| Date of Decision | 20-Mar-2013 |
| Date of Acceptance | 28-Mar-2013 |
| Date of Web Publication | 29-Apr-2013 |
Correspondence Address:
Sushin Park
Department of Neurology, Wonkwang University School of Medicine, Jeonbuk Regional Cardio Cerebrovascular Disease Center, 344-2 Shinyong-dong, Iksan
South Korea
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.111147
How to cite this article:
Park S, Lee HS, Cheong JS, Ha YS. "Target sign" in an intracranial vertebral artery dissection with isolated vertigo. Neurol India 2013;61:183-4 |
Sir,
Isolated vertigo can be the only manifestation of ischemia in the vertebrobasilar tertiary, [1] while patients with transient ischemic attack show isolated perfusion-weighted imaging abnormalities. [2]
A 40-year-old man known case of hypertension presented with the sudden onset vertigo and disequilibrium. His symptoms resolved after several hours. This patient underwent brain magnetic resonance imaging (MRI) and magnetic resonance angiography. Diffusion-weighted MRI was normal, but a perfusion-weighted MRI revealed a restricted flow in the right medulla [Figure 1]a and b. MR-angiogram showed occlusion of the right vertebral artery [Figure 1]c. High-resolution MRI, which allows visualization of the lumen, revealed a "target sign" [Figure 1]d. [3] We diagnosed ischemia of the medulla due to intracranial vertebral artery dissection. After anticoagulation therapy 4 months later, a repetition of the high-resolution MRI of the brain revealed recanalization of the right vertebral artery [Figure 1]e and f. | Figure 1: (a) Brain magnetic resonance imaging (MRI) and magnetic resonance angiography. (b) Diffusion-weighted MRI revealed no remarkable abnormalities. Perfusion-weighted time-to-peak MRI showed restricted flow in the right lateral medulla. (c) An MR angiogram documented a right vertebral artery occlusion. (d) 3T high-resolution T2- weighted MRI revealed a "target sign" appearance caused by sub intimal dissection with hematoma of the right intracranial vertebral artery. (e and f) 4 months later, MRI showed that the right vertebral artery dissection was recanalized
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Dissection is a treatable cause of stroke. Spontaneous intracranial vertebral artery dissection with vertigo as an isolated symptom is rare, but should be considered, Particularly in young adult.
| » References | |  |
| 1. | Gomez CR, Cruz-Flores S, Malkoff MD, Sauer CM, Burch CM. Isolated vertigo as a manifestation of vertebrobasilar ischemia. Neurology 1996;47:94-7. 
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| 2. | Restrepo L, Jacobs MA, Barker PB, Wityk RJ. Assessment of transient ischemic attack with diffusion- and perfusion-weighted imaging. AJNR Am J Neuroradiol 2004;25:1645-52.
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| 3. | Hunter MA, Santosh C, Teasdale E, Forbes KP. High-resolution double inversion recovery black-blood imaging of cervical artery dissection using 3T MR imaging. AJNR Am J Neuroradiol 2012;33:E133-7.
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[Figure 1]
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