ABSTRACT NUMBER: ESOC2026A1673 VERTEBRAL ARTERY DISSECTION PRESENTING AS POSITION-TRIGGERED EPISODIC VERTIGO IN A YOUNG WOMAN: A CASE REPORT

Abstract Background and aims Vertebral artery dissection (VAD) is a major cause of posterior circulation stroke in young adults, but may initially present with isolated vertigo mimicking benign vestibular disorders, risking misdiagnosis and treatment delay. Methods We describe a previously healthy 38-year-old woman with acute episodic, position-triggered vertigo, detailing clinical examination, neuroimaging, vascular work-up, management and short-term follow-up. Results The patient reported one week of brief vertigo episodes precipitated by head movement, each lasting seconds and without nausea, vomiting, tinnitus or hearing loss. Examination revealed impaired left eye adduction with right abduction nystagmus, mild left-sided limb dysmetria and wide-based gait, without spontaneous nystagmus or long-tract signs. Brain MRI demonstrated a subacute infarct in the left cerebellar hemisphere with corresponding restricted diffusion. Routine laboratory tests, autoimmune and thrombophilia screening, transthoracic echocardiography and Holter monitoring were unremarkable. CT angiography showed a small dissection flap with eccentric mural thrombus in the V1 segment of the left vertebral artery, causing approximately 30% luminal narrowing and explaining the VAD-related cerebellar infarction. She was treated with aspirin and high-intensity statin therapy, with complete resolution of symptoms during an 11-day admission and no recurrence at four-week follow-up. Conclusions This case illustrates that VAD may present with brief, position-triggered vertigo resembling benign paroxysmal positional vertigo. Careful assessment for central ocular motor signs and subtle ataxia in “peripheral-appearing” vertigo, particularly in young patients, should prompt early MRI and targeted vascular imaging to exclude posterior circulation stroke and enable timely secondary prevention. Conflict of interest Dibij Adhikari: nothing to disclose, Sobin Pant: nothing to disclose, Raju Pandit: nothing to disclose, Jayaram Lamichhane: nothing to disclose, Bikram Gajurel: nothing to disclose