# Bilateral Vertebral Artery Dissection in the V1 and V4 Segments Induced by Artery Anomalies and Risk Factors

## TL;DR

A rare case of bilateral vertebral artery dissection in two segments is reported, possibly triggered by a high pillow and pregnancy-related risk factors in a woman with a pre-existing artery anomaly.

## Contribution

This case highlights the potential risk of vertebral artery dissection in individuals with known artery anomalies and emphasizes the importance of risk management.

## Key findings

- Bilateral vertebral artery dissection occurred in both V1 and V4 segments in a patient with a vertebral artery anomaly.
- High pillow use during the puerperium is suspected to have triggered the dissection despite a long-standing anomaly.
- The case underscores the need for careful monitoring and awareness of dissection risks in individuals with vertebral artery anomalies.

## Abstract

Bilateral vertebral artery dissection (VAD) is rare, particularly in the extracranial V1 segment. We report a case of bilateral VAD (V1 and V4 segments) in a patient with a vertebral artery anomaly, potentially triggered by the puerperium and high pillow use. A 35-year-old primiparous woman with a history of migraine developed worsening headaches after starting to use a high pillow. Computed tomography angiography revealed bilateral VAD in the V1 and V4 segments and a vertebral artery anomaly. Magnetic resonance imaging and ultrasound examinations confirmed a temporal phase difference in the intramural hematomas of both vertebral arteries. Despite having an anomalous vertebral artery for 35 years without dissection, the high pillow use during the puerperium is suspected to have triggered the dissection. Vertebral artery anomalies are present in a small percentage of the population and are not uncommon. When detected during routine health checkups, it is crucial to raise awareness of their potential risk for dissection and the importance of risk management. Furthermore, in cases of unilateral VAD, careful monitoring is warranted, as contralateral or multi-segmental dissection may be induced.