Cerebellar infarction after sneezing.
Gustavo Bittencourt CamiloMarco Antônio RiccioAnna Luíza Machado NogueiraAmanda Campos QuerubinoAna Luísa Dos Santos MacielDaniela Girardi Pereira Linhares RodriguesCarlos Alberto Corrêa de Sá JúniorPublished in: Revista da Associacao Medica Brasileira (1992) (2021)
Vertebral Artery Dissection (VAD) is a rare condition that can be caused by a wide amplitude of neck movement, which injures the vessel wall and can cause ischemia in the cerebellum. We present a 37-year-old man with herniated lumbar disc and allergic rhinosinusitis, which caused sneezing spells. After one of these bouts with a ricochet of the head, he presented C3 misalignment with local pain. Twenty-one days later, affected by a new crisis, he presented left temporal headache, nystagmus, and vertigo. After 3 days, Magnetic Resonance Imaging (MRI) identified 2 regions of cerebellar ischemia and filling failure of the right vertebral artery. After 2 days, Computed Angiotomography (CT Angiography) was performed and showed right VAD with a local thrombus, without aneurysmal signs. Transcranial Doppler did not indicate an increase in blood flow from this artery. The suggested treatment involved administration of anticoagulant Apixabana 5mg, 12/12h, for 3 months, until the condition was reevaluated with new Angio CT and MRI. It was recommended that the patient was released from work for 1 month and forbidden from doing intense physical exercises for 3 months; however, due to setbacks, these deadlines were extended until a new appointment, 4 months after the first visit. The new tests showed no changes, indicating that the condition was stable. This case aims to indicate the possible investigations of the diagnosis and therapeutic options of the rare association between VAD with cerebellar infarction in a well-documented case.
Keyphrases
- blood flow
- contrast enhanced
- magnetic resonance imaging
- diffusion weighted imaging
- computed tomography
- bone mineral density
- magnetic resonance
- chronic pain
- public health
- minimally invasive
- venous thromboembolism
- pain management
- mental health
- body composition
- physical activity
- neuropathic pain
- combination therapy
- optical coherence tomography
- postmenopausal women
- optic nerve
- resistance training
- functional connectivity