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Case 2
• 67 yrs, M, HTN, DM with retinopathy.
• Unsteady gait and left facial weak on 99-5-5 at
Liou-Ying CMH.
• Re-admitted to Yong-Kung CMH on 5-15, with
s/s deterioration was told (55-).
• Headache with mild intensity of throbbing
character (not the obvious complaints).
• No trauma history recently.
• Headache heralded s/s of limb weakness.
• 198/100, 90/min, MP 5/5-.
• Lab(+): D-dimer=527 (<500),
hs-CRP=74.3 (<3), Hb 11.6.
PT/APTT = wnl.
• Cardiac echo:no vegetation,
no cardiomegaly.
• 5/5- CT ( and 5/15)
• 5/6-MRI (and 5/17)
CT (99-5-5)
MRI (99-5-6)
MRA(99-5-6)
MRA (99-5-17, 5-20)
MRI f/u (99-05-17)
Cases talk…
• Both patients are recovered well, after
anti-platelet.
• Headache heralds the s/s of stroke.
• Mild intensity, of throbbing headache
in our cases.
Cases in literature saying…
• Headache, including neck and facial pain, can be constant,
instantaneous, gradual, throbbing, or sharp.
• Headache is commonly ipsilateral to the dissected artery.
• Headache usually precedes a cerebral ischemic event.
• Cluster-like headache with pain centered in or around the eye
has also been described in a case of spontaneous internal carotid
artery dissection.
• Headache has been described to persist, in some cases, for years
after the dissection.
(eMedicine, 2009)
Cases in literature …
• Hs-CRP is higher in spontaneous cervical
dissection rather than in traumatic
dissection.(retrospective cases-control study)
• The mechanism is still unknown.
(J Neurology, 2006; 253:741-745)