(Kiosk 4) Wallenberg Syndrome in a Young Female Due to Spontaneous vs Trauma Induced Vertebral Artery Dissection

Case Diagnosis: A young female with spontaneous vs. trauma-induced vertebral artery dissection leading to cervicomedullary junction ischemic infarct and lateral medullary syndrome.

Case Description: A 39-year-old female with history of anxiety and prothrombin G2021A mutation without personal history of VTE presented with intractable headache for 1 week. Reportedly, she slipped on ice and struck the back of her head 3 weeks prior with resulting pain radiating behind her right ear into her temple when turning her head to the right. In the emergency department, the patient developed intermittent facial paresthesias and decreased sensation on her left side. She also reported a right-sided lean when walking. Initial MRI was negative. CTA head/neck demonstrated right vertebral artery dissection with mural hematoma. Repeat MRI with thin cuts showed acute right cervicomedullary junction infarction.

Discussion: This patient initially presented with what appeared to be spontaneous vertebral artery dissection with resulting stroke. One week following discharge from rehab, the patient presented to the emergency department after her spouse grabbed her by the neck and threw her to the ground. She was found to have left vertebral artery dissection without acute infarct at that time.

Setting: Acute inpatient rehabilitation.

Assessment/Results: Upon admission to rehab, the patient's primary symptoms included double vision, dysarthria, hoarseness, headaches, right sided facial numbness, and right eye dryness, consistent with Wallenberg syndrome. She was discharged home at the modified independent level 2 weeks later.

Conclusion: Initially, this patient's stroke appeared to be due to spontaneous vertebral artery dissection. Her second admission with contralateral vertebral artery dissection as a result of direct trauma in the setting of domestic violence raises concern that her prior vertebral artery dissection could have a similar etiology. In a young patient with spontaneous vertebral artery dissection, domestic violence and other traumatic causes should be considered and social screening should be performed.