On February 18, 2006, I suffered a dissection of the left vertebral artery

in the back of the neck, leading to two strokes in the cerebellum. As my

dissection did not happen in the aorta, I hesitate to submit my case to your

excellent website. However, I thought I would write to you about my

dissection.

I am Chinese, male, and 54 years old. I was in good health. About 2 to 3

years ago, I had a stress test, which came out well. This morning my BP was

115/81 and blood sugar was 121 mg/dl (fasting). I am 5’ 9” and 180 lbs.

(I’m “big boned” and not fat.) I have never smoked and do not drink

alcohol. I am diabetic Type 2.

Back in mid-February I was breaking and cutting wood for firewood in my

backyard in frigid weather. I have cut wood many times before. But this

time, I came inside the house and experienced severe vertigo and then threw

up. According to the doctors, what I suffered was a vertebral dissection of

a blood vessel in the back of the neck. It led to two clogs in the right and

left sides of the cerebellum and strokes. It landed me in one hospital for

about 5 days. The hospital released me, but then next day I suffered

extreme headache (due to hemorrhaging in the brain) and I stayed at another

hospital for more days.

I was discharged from the second hospital a little more than 2 months ago.

The doctors believe that the dissection was due to the physical exertion of

swinging a heavy mallet. The doctors do not want me to lift anything heavy

or get a neck massage or get any chiropractic manipulation on the neck or

carry a backpack from now on.

I am under the care of 2 doctors. I am on disability leave from work and

recovering at home. The doctors say it will take about 3-6 months (from

Feb) for the dissection to heal. I am taking baby aspirin (81 gm) daily.

I have several questions:

1. Is my case of vertebral dissection rare, since most dissections are in

the aorta and carotid arteries? Have you heard of cases of vertbral

dissection?

2. Was physical exertion the cause of the dissection? I have cut wood many

times and engage in many types of physical exertion before? Certainly many

other people have performed heavier physical exercise than I have.

3. I have had persistent headaches for long periods since the stroke. They

have gone away for 2 weeks. They are relatively mild, about a 0.5 to 4 on

the pain scale. The doctors do not know why I have gotten these headaches.

Do you have any idea of why?

Thanks. I look forward to any ideas you might have. Thank you very much

for your outstanding website.

Answers to Questions:

I'm not an expert on vertebral dissections so take what I say with a heavy dose of skepticism.

Vertebral dissections as you correctly state are fairly rare. They have been described in association with chiropractic manipulation or other abrupt distortions of the neck. Whether the wood chopping had anything to do with the dissection is hard to say with any certainty. It is temporally correlated and the rise in blood pressure due to the exertion may have been the final straw, but I would have to suspect that there was some other inherent weakness in the artery that set the stage for this. The other possibility especially if the dissection started lower in the vertebral artery is that motion of lifting the arms strenuously overhead to raise the ax may have started the tear. The vertebral arteries arise form the subclavian artery which is the artery that feeds the arm The sibclavian passes close to the clavicle, so perhaps as you were cutting the wood the clavicle pulled or pinched the vertebral as it was originating form the subclavian artery. Perhaps the anatomy of how your vertebral takes-off from the sibclavian may have place dyo at risk.

In any case the recommendation to stay away from chiropractors and wood chopping probably make sense. whether all strenuous activities need to be avoided is less clear. Certainly until your neuroligic symptoms have resolved it makes sense.

Headaches after an intracranial bleed is not uncommon. They should subside over time.

David

John Wong, Ph.D.