ABSTRACT NUMBER: ESOC2026A745 BILATERAL VERTEBRAL DISSECTION AS UNCOMMON CAUSE OF ISCHEMIC STROKE

Abstract Background and aims Vertebral dissections are an uncommon but severe cause of ischemic stroke, with mainly presentation in young people. They use to be unilateral and trauma is the most frecuent etiology, although they are multiple causes, assuming a diagnosis challenge. Methods We present two cases of ischemic stroke due to bilateral vertebral arterial dissections. First case: 30 year old woman, postpartum, without previously history, with suddenly left cervical pain, blurred visión, bradypsychia and generalizated weakness. In physical examination is observed a right superior quadrantanopia and mild dysarthria. NIHSS: 2 Second case: 42 year old woman, without previously history, with Horner síndrome, left facial palsy, dysphagia and gait inestability. NIHSS: 1. Results In first case urgent neuroimaging didn´t show abnormalities but damped doppler flow in right vertebral arteria (VA) and left-posterior cerebral arteria in ultrasound doppler test. In the second case, multimodal CT showed left VA oclussion. Antithrombotic treatment was iniciated in both cases. MRI was performed, with diffusion restriction in thalamus, left occipital lobe and right cerebellar hemisphere in first case and left lateral bulbar región in second case. Magnetic resonance angiography evidenced bilateral VA dissection in both cases. After finishing etiology study, it is concluded that first case was associated to postpartum and second case to fibromuscular dysplasia. Conclusions Low incidence of vertebral dissection, particullary bilateral, assumes a diagnosis and treatment challenge, being essential an early management to avoid complications and improve the outcome. Conflict of interest All of authors have nothing to disclose