A Physician Battles With Neck Pain After A Surface-supplied Diving Excursion

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A Physician Battles With Neck Pain After A Surface-supplied Diving Excursion - Page #3

Lab Studies: CMP and CBC were unremarkable with HbA1C 5.6% (normal = less than 5.7%) and TSH 1.73 mIU/L (normal range 0.40-4.50). Other Studies: CT head showed no acute process. MRI brain showed no acute stroke, no hemorrhage, no contrast enhancing lesions. MRA Head/Neck was significant for distal right vertebral artery V2 dissection with mural hematoma on fat saturation images and lack of opacification through the V4 portion. Case Photo #1 On the image, the arrows highlight the right vertebral artery, which is attenuated throughout. The most inferior arrow highlights where the dissection begins. The vessel appears irregular starting there and moving superior. As one follows the arrows up, a clear view of the vessel is lost, likely because the blood flow is significantly weakened through the vessel due to the dissection. The vessel also appears to be experiencing a spasm, likely from the stress of the dissection. The spasm is also causing the vessel to appear attenuated and irregular. Case Photo #2 On the second photo, the arrows highlight the right vertebral artery, which is very faint compared to the left vertebral artery which indicates that blood flow through the right vertebral artery is significantly reduced. Of note, the dissection is occurring just distal to what is seen in the second photo. CTA Head and Neck showed dissection with impaired blood flow extending from the distal right V2 through the V4 portion with basilar retrograde filling. MRV Brain showed no sinus venous thrombosis. Echocardiogram showed left ventricular ejection fraction 65%, no patent foramen ovale and valves normal. Consultations: Neurology Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.		Back
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