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Dissection of the Intracranial Vertebral Artery Neurol 38:868-877, Caplan,L.R.,et al, 1988 See this aricle in Pubmed Article Abstract We describe four patients and review prior reports to clarify the clinical,radiographic,and pathologic findings of intracranial vertebral artery(VA)dissection.A 43-year-old man and a 33-year-old woman had chronic bilateral VA dissecting aneurysms.The man had multiple episodes of subarachnoid hemorrhage(SAH)and necropsy showed multiple dissections and defects in the unilateral dissections.Intracranial VA dissection causes four overlapping syndromes:(1)brainstem infarcts are usually due to subintimal dissection extending into the basilar artery,affect younger patients,and often are single fatal events;(2)SAH is due to subadventitial or transmural dissection;(3)aneurysms cause mass effect on the brainstem and lower cranial nerves;and(4)chronic dissections due to connective tissue defects cause extensive bilateral aneurysms and repeated TIAs,small strokes,and SAH.

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