Figure 1.

Cranial CT and MRI images at onset of vertebral artery dissection after massage in a 32-year-old woman. (A) CT shows a patchy low-density area in the deep white matter of the right temporal lobe, suggesting ischemic lesion (arrow). (B, C) Diffusion weighted imaging (DWI) of brain reveals patches and plaques of high signal intensities (arrows) in the bilateral deep temporal lobes, the right occipital cortex, the pons, and the bilateral cerebellar hemispheres. Diagnosis of multiple acute cerebral infarcts were considered."

Figure 2.

Digital subtraction angiography (DSA) of the vertebral artery before and right after stent placement for vertebral artery dissection after massage in a 32-year-old woman. (A, B) Significant eccentric stenosis at the proximal V4 segment of the left vertebral artery is depicted on DSA images, with localized dilation of distal segment and an obvious local rectangular notch (arrow), consistent with arterial dissection. (C, D) After stent implantation, the vascular eccentric stenosis was alleviated, the vascular wall was smooth, and the local notch disappeared (arrow). The distal vessel remained dilated, and the proximal vessels presented vasospasm due to the passage of the guidewire."

Figure 3.

Cranial computed tomography angiography 3 and 6 months after stent placement for vertebral artery dissection in a 32-year-old woman. (A, B) at 3 months postoperatively; (C, D) at 6 months postoperatively. A localized stenting shadow (arrows) was observed in the vertebral artery segment V4 passing through the foramen magnum with smooth blood flow inside the stent and no stenosis."

Figure 4.

MR DWI and DSA follow-up one year after the stent placement for vertebral artery dissection in a 32-year-old woman. (A, B) No new cerebral infarction lesions were found on brain DWI images. (C, D) A stent implantation shadow in the V4 segment of the vertebral artery presented on DSA images. Compared with the DSA findings, the local lumen had completely returned to normal, the proximal and distal vessels were of the same diameter, the vessel wall appeared smooth, and the endovascular notch completely disappeared."

Figure 5.

Timeline of onset, treatment, and follow-up of a 32-year-old woman with diagnosis of vertebral artery dissection after massage. NIHSS:National Institutes of Health Stroke Scale."

Table 1.

Clinical data of three cases with vertebral artery dissection after neck massage reported in the literatures"