Vertebral artery dissection as the initial manifestation of primary antiphospholipid syndrome in a man

Antiphospholipid syndrome (APS) is a prothrombotic autoimmune disorder that is associated with arterial and venous thrombosis. Cervical artery dissection is an uncommon cause of stroke and has rarely been reported with APS. We report the case of a 46-year-old man who presented with acute dizziness, vertigo, neck pain, and headache after jujitsu training. Neuroimaging showed right vertebral artery dissection from V1 to V4, and magnetic resonance imaging revealed a right cerebellar infarction. Evaluation revealed persistently elevated lupus anticoagulant titers on repeat testing at 12-week intervals, satisfying the 2023 criteria for primary APS. The dissection was likely mechanically triggered, while APS may have amplified thrombotic risk and altered secondary prevention toward long-term warfarin.