Spontaneous Resolution of Nontraumatic Bilateral Intracranial Vertebral Artery Dissections: Case Report

A 49-year-old man presented with nontraumatic bilateral intracranial vertebral artery dissections without subarachnoid hemorrhage manifesting as Wallenberg's syndrome on the right. Magnetic resonance imaging revealed an infarct in the right dorsolateral aspect of the medulla oblongata. Antiplatelet therapy was administered. Vertebral angiography performed on the 9th hospital day (Day 9) revealed pearl and string sign in the right vertebral artery and narrowing of the left vertebral artery. Second angiography performed on Day 25 showed no change, but third angiography performed on Day 74 revealed spontaneous resolution of the bilateral vertebral artery dissections. Magnetic resonance angiography performed on Day 250 showed no evidence of dissection. However, magnetic resonance imaging revealed a small infarct in the splenium of the corpus callosum. Spontaneous resolution of stenotic dissections of the bilateral vertebral arteries is extremely unusual. Serial cerebral angiography and magnetic resonance angiography are very important for monitoring the time course of changes in patients with vertebral artery dissections.