Subarachnoid haemorrhage due to intracranial vertebral artery dissection presenting with atypical cauda equina syndrome features: case report
File(s)
Author(s)
Steele, Lloyd
Raza, Muhammad Hasan
Perry, Richard
Rane, Neil
Camp, Sophie J
Type
Journal Article
Abstract
BACKGROUND: Failing to recognise the signs and symptoms of subarachnoid haemorrhage (SAH) causes diagnostic delay and may result in poorer outcomes. We report a rare case of SAH secondary to a vertebral artery dissection (VAD) that initially presented with cauda equina-like features, followed by symptoms more typical of SAH. CASE PRESENTATION: A 55-year-old man developed severe lower back pain after sudden movement. Over the next 5 days he developed paraesthesiaes in the feet, progressing to the torso gradually, and reported constipation and reduced sensation when passing urine. On day six he developed left facial palsy, and later gradual-onset headache and intermittent confusion. Magnetic resonance imaging of the brain showed diffuse subarachnoid FLAIR hyperintensity, concerning for blood, including a focus of cortical/subcortical high signal in the left superior parietal lobule, which was confirmed by computed tomography. Digital subtraction angiography demonstrated a left VAD with a fusiform aneurysm. CONCLUSION: We present a very rare case of intracranial VAD with SAH initially presenting with spinal symptoms. The majority of subsequent clinical features were consistent with a parietal focus of cortical subarachnoid blood, as observed on neuroimaging.
Date Issued
2019-10-30
Date Acceptance
2019-10-06
Citation
BMC Neurology, 2019, 19 (1)
ISSN
1471-2377
Publisher
BioMed Central
Journal / Book Title
BMC Neurology
Volume
19
Issue
1
Copyright Statement
© The Author(s). 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/31666024
PII: 10.1186/s12883-019-1487-z
Subjects
Aneurysm
Case report
Dissecting
Facial nerve
Headache
Hypesthesia
Subarachnoid hemorrhage
Vertebral artery
Publication Status
Published
Coverage Spatial
England
Article Number
ARTN 262