Abstract 315: Intraventricular hemorrhage due to bilateral vertebral artery dissection during treatment in drug intoxication patient: a case report

Introduction A vertebral artery dissection is a possible cause of stroke in young and middle‐aged adults without risk factors for cerebrovascular disease. It often occurs spontaneously for no particular reason, but it can also occur due to trauma or other causes. This study aims to report the treatment experience of bilateral vertebral artery dissection and intraventricular hemorrhage in a patient hospitalized for drug intoxication in our hospital. Methods A fifty‐six‐year‐old woman was found collapsed on the street and visited the emergency department of our hospital, complaining of comatose mentality and hypothermia. The Glasgow Coma Scale score measured at the visit was 3 points, and bradycardia and hypotension were present. A bag of medications prescribed by a psychiatrist was found in the patient's bag, and a drug screen test performed showed benzodiazepines positive. Brain CT performed in the emergency room did not reveal an acute lesion, so the patient was admitted to the intensive care unit at the department of emergency medicine under a drug intoxication impression. After four days of hospitalization, the patient's response started to improve, and on the 7th day, she showed a drowsy mentality. IVH was found in the bilateral lateral ventricles on diffusion MR performed on day 7, and dissection was confirmed in the bilateral distal V4 segment on additional CT angiography. Results Conservative treatment was performed in the intensive care unit, and a follow‐up CT showed that the hemorrhage was resolved. Still, dissecting aneurysms with an increased size was confirmed in both V4 segments. Emergency stent‐assisted coil embolization was performed for left V4 dissecting aneurysm with bleb. There were no complications during the procedure, and the right V4 dissecting aneurysm was decided to do embolization after a follow‐up examination. After the procedure, the patient showed an alert mentality, and there were no acute abnormal findings in the follow‐up examination. In the MRA performed one year after the procedure, the treated area on the left V4 dissecting aneurysm was well maintained. The right V4 dissecting aneurysm showed normal findings due to spontaneous healing. Conclusion In the case of vertebral artery dissection, which rapidly changes shape, careful observation is required, and appropriate treatment is required before new neurological symptoms develop. For treatment, stent‐assisted coil embolization can be a good option, and since spontaneous healing can occur in some cases, it is essential to determine an appropriate treatment method. In addition, appropriate follow‐up tests and identification of the cause are necessary for patients with decreased consciousness for which the cause is unclear.