Vertebral Artery Dissection Caused by Neck Tics

Abstract

Vertebral arterial dissection (VAD) is a rarely observed cause of vertebrobasilar ischemia. It is often reported as individual case reports in children, and the underlying cause is usually congenital anomalies or trauma to the neck. In this case report, we present a pediatric case of VAD whose magnetic resonance (MR) and computed tomography angiographies were normal and could only be diagnosed after a careful reassessment of the initial brain MRIs considering the dynamic nature of the dissection process. Etiological investigations pointed to the patient's neck tics as the origin of the condition, which is a rare and interesting cause different from the previously reported cases in the literature. Due to the ischemic lesions in the brain stem and the cerebellum, low molecular weight heparin treatment was started and the neurological symptoms rapidly receded. Since a severe tic disorder involving the face and neck has been observed as a rare cause of VAD aside from the previously reported causes such as the Bow-Hunter syndrome reported in archers, congenital cervical anomalies, traumatic mechanical accidents, and cervical chiropractical maneuvers, the sharing of this case will contribute to the literature. © 2018 by Georg Thieme Verlag KG, Stuttgart. New York.