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Spontaneous dissection of the major arteries of the neck is known to increase the risk of stroke or transient ischaemic attack in young and middle-aged adults. Most of the reported cases of arterial dissections in the neck involve one or both paired extracranial carotid or vertebral arteries. Spontaneous dissection of the bilateral internal carotid and vertebral arteries is extremely rare. We report a case of spontaneous bilateral internal carotid artery and vertebral artery dissection while using a prescribed pill for weight loss which contained amphetamine derivative. A review of literature is also provided.

BackgroundThe optimal management strategy for unruptured cerebral arteriovenous malformations (AVMs) is controversial since the ARUBA trial (A Randomized trial of Unruptured Brain AVMs). An accurate understanding of the morbidity associated with AVM hemorrhages may help clinicians to formulate the best treatment strategy for unruptured AVMs.ObjectiveTo determine the morbidity associated with initial cerebral AVM rupture in patients presenting to tertiary medical centers.MethodsRetrospective chart reviews from three tertiary academic medical centers were performed for the period between 2008 and 2014. All patients admitted with intracranial hemorrhage due to untreated AVMs were included in this study. Patient-specific variables, including demographics, imaging characteristics, neurologic examination results, and clinical outcome, were analyzed and recorded.Results101 Patients met the inclusion criteria. Admission National Institutes of Health Stroke Scale (NIHSS) scores were 0, 1–9, and ≥10 in 26%, 29%, and 45% of patients, respectively. Hematoma locations were subarachnoid, intraventricular, intraparenchymal, and combined in 5%, 11%, 32%, and 52% of patients, respectively. Deep venous drainage was present in 43% of AVMs; AVM-associated aneurysms were present in 44% of patients. Emergent hematoma evacuations were performed in 37% of patients and 8% of patients died while in hospital. At discharge, of those who survived, NIHSS scores of ≥1 and ≥10 were found in 69% and 23%, respectively. At the 90-day follow-up, 34% had a modified Rankin Scale (mRS) score >2. Patients with admission NIHSS score ≥10 had significantly higher rates of midline shift, surgical hematoma evacuation, and follow-up mRS ≥3 (pConclusionsThe morbidity associated with cerebral AVM rupture appeared to be higher in our study than previously reported. Morbidity from AVM rupture should be considered as an important factor, together with variables such as risk of AVM rupture and procedural risk, in determining the optimal treatment strategy for unruptured cerebral AVMs.

Objective To assess the safety and efficacy of different endovascular treatment modalities in young adults with acute ischemic stroke (AIS). Background Stroke in young adults is less common compared to the elderly but forms a significant burden in terms of morbidity and mortality. Endovascular therapies for AIS are relatively new modalities showing great promise. Data regarding their efficacy in this population is scant. Design/Methods Retrospective chart review was performed in 188 consecutive patients who underwent endovascular treatments for acute ischemic stroke at our center between 2005 and 2009, and the patients between the ages of 18–45 were selected for further review (n=11). Their demographics were studied and the outcomes measured were post intervention rates of recanalization, asymptomatic and symptomatic hemorrhages and mortality. Results Of the 11 patients age 18–45 (mean age 38.63±8.26), 54%(n=6) were female, 27.2% (n=3) were hypertensive and 9% (n=1) patients were diabetic. The mean NIHSS on admission was 15 and that on discharge was 6.5. The majority of the patients (n=9) had lesions in the anterior circulation, 5 of which were in the internal carotids, 2 were proximal MCA and 3 were distal MCA (M2/M3) branches. Vertebral and basilar artery occlusions were found in one patient each. All of these patients received a combination of intravenous and intra-arterial tPA. In addition, three patients received mechanical thrombectomy with MERCI (n=2) or Penumbra (n=1) retrieval devices. Complete recanalization (TIMI 3) was achieved in 27.2% (n=3) patients; partial recanalization (TIMI 2) was achieved in 54.5% (n=6) patients and no recanalization in 18.1% (n=2) patients. 18.1% (n=2) patients had asymptomatic and none(n=0) of the patients had symptomatic intracerebral hemorrhages detected on follow-up CT scans at 24 h post procedure.There were no mortalities. Conclusions Combined intravenous and endovascular therapies proved to be a relatively safe and efficacious treatment modality for young patients with acute ischemic stroke, and these patients tended to have better outcomes than those reported for the general population.