Garewal M, Selhorst JB. Arch Neurol 2005; 62:1917-1919.
Background-- subclavian dissection is rare, and is usually associated with anomalies of the aortic arch, trauma or catheterization. The main clinical manifestations are chest and back pain preceding stroke, often with pain and weakness in the arm. This contrasts with vertebral artery dissection that is associated with headache and neck pain and arm pain/weakness.
In the case described, a 54 year old hypertensive developed crushing intrascapular pain and vertigo and vomiting and could not lift his arm over his head. His father had had an abdominal aortic aneurysm. He had decreased pinprick perception on his left lower jaw. He had weak deltoid, triceps, supraspinatus, and triceps. He had decreased left biceps and triceps jerks. He had dysmetria bilaterally and an ataxic gait. His radial arteries WERE SYMMETRIC!. DWI showed a left cerebellar stroke. On angio he had a subintimal thrombus in the subclavian artery. He improved over a month or two. The authors describe 3 strokes: cerebellar, spinal between C4 and C5, and multiple rootlet infarction with weak arms and denervation on EMG study.
The lit review describes a patient who developed subacute thoracic pain and bilateral arm pain.
Background-- subclavian dissection is rare, and is usually associated with anomalies of the aortic arch, trauma or catheterization. The main clinical manifestations are chest and back pain preceding stroke, often with pain and weakness in the arm. This contrasts with vertebral artery dissection that is associated with headache and neck pain and arm pain/weakness.
In the case described, a 54 year old hypertensive developed crushing intrascapular pain and vertigo and vomiting and could not lift his arm over his head. His father had had an abdominal aortic aneurysm. He had decreased pinprick perception on his left lower jaw. He had weak deltoid, triceps, supraspinatus, and triceps. He had decreased left biceps and triceps jerks. He had dysmetria bilaterally and an ataxic gait. His radial arteries WERE SYMMETRIC!. DWI showed a left cerebellar stroke. On angio he had a subintimal thrombus in the subclavian artery. He improved over a month or two. The authors describe 3 strokes: cerebellar, spinal between C4 and C5, and multiple rootlet infarction with weak arms and denervation on EMG study.
The lit review describes a patient who developed subacute thoracic pain and bilateral arm pain.
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