Diagnostic Challenges in Atypical Presentations of Spontaneous Vertebral Artery Dissection

Vertebral artery dissection (VAD) is a notable cause of stroke, especially in young individuals. This case reports the diagnosis of ischemic stroke in the right cerebellar hemisphere and posterior medulla on the right side, secondary to dissection of the V3 segment of the right vertebral artery of a 24-year-old female. She presented with the chief complaint of vertigo and double vision for a duration of one day. Her initial symptoms presented one day before, which were excruciating pain in her right ear and subsequent temporary hearing loss in the same ear. The patient had significant nystagmus. Computed tomography scan of the head and computed tomography angiography were negative for acute findings. Magnetic resonance imaging of the head with contrast was done, indicating an acute/subacute ischemic stroke in the right cerebellar hemisphere and posterior medulla on the right side. MRI of the neck showed occlusive dissection of the V3 segment of the right vertebral artery. Dual antiplatelet therapy was initiated with aspirin and Brilinta. This case highlights the importance of recognizing and diagnosing VAD in a timely manner, especially in patients with atypical symptoms.