{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:58:27Z","timestamp":1769727507889,"version":"3.49.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","license":[{"start":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T00:00:00Z","timestamp":1721001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2024,7,15]]},"abstract":"\n BACKGROUND<\/jats:title>\n The reported actual risk of rupture for vertebral artery dissection (VAD) in patients presenting with headache is very low, ranging from 0.4% to 1.0%. The authors report a case in which the dissection site dilated rapidly within several hours after the dissection occurred resulting in subarachnoid hemorrhage (SAH).<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 49-year-old healthy man who had participated in a marathon noticed a headache while running. Magnetic resonance imaging (MRI) performed 2 days later revealed no findings suspicious for right VAD, but a string sign was observed in the left side, suggesting left VAD. Three hours following MRI, he developed severe headaches and became unconscious at home, prompting emergency services to rush him to the hospital. A computed tomography scan showed diffuse SAH and a rapidly enlarged aneurysmal dilatation in the right vertebral artery. He underwent endovascular internal trapping to prevent rebleeding. He was discharged without any neurological symptoms. No recurrence or new dissection occurred after 2 years of follow-up.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Even in the absence of typical imaging findings, strict management, such as blood pressure control, is required when clinical findings strongly suggest VAD, and differentiation of VAD from primary headache is important.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24202<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24202","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T02:50:44Z","timestamp":1721011844000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute morphological changes of impending rupture of vertebral artery dissection: clinical management of symptomatic but unruptured vertebral artery dissection. Illustrative case"],"prefix":"10.3171","volume":"8","author":[{"given":"Tatsuya","family":"Mori","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaki","family":"Iwakura","sequence":"additional","affiliation":[{"name":"Iwakura Neurosurgery and Headache Clinic, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Imura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kana","family":"Onobuchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masaaki","family":"Kohta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hidehito","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Sasayama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"J Neurosurg","first-page":"962","article-title":"A fatal, chronically growing basilar artery: a new type of dissecting aneurysm","volume":"84","author":"Mizutani","year":"1996","unstructured":"Mizutani T. A fatal, chronically growing basilar artery: a new type of dissecting aneurysm. J Neurosurg. 1996;84(6):962-971."},{"issue":"4","key":"bib2","series-title":"Surg Cereb Stroke (Jpn).","first-page":"252","article-title":"A nationwide study of intracranial arterial dissection in the vertebrobasilar system (part 2): outcomes in hemorrhagic-onset cases","volume":"43","author":"Tajima","year":"2015","unstructured":"Tajima YOno JIHiguchi YMachida TSaeki NYamaura A. A nationwide study of intracranial arterial dissection in the vertebrobasilar system (part 2): outcomes in hemorrhagic-onset cases. Surg Cereb Stroke (Jpn).2015;43(4):252-256."},{"issue":"4","key":"bib3","series-title":"J Neurosurg","first-page":"1037","article-title":"Natural course of intracranial arterial dissections: clinical article.","volume":"114","author":"Mizutani","year":"2011","unstructured":"Mizutani T. Natural course of intracranial arterial dissections: clinical article.J Neurosurg. 2011;114(4):1037-1044."},{"issue":"5","key":"bib4","series-title":"J Neuroendovascular Ther","first-page":"265","article-title":"A case of intracranial vertebral artery dissection undetected by CT, MRI, and MRA at the onset of headache that caused subarachnoid hemorrhage seven days later","volume":"16","author":"Inoue","year":"2022","unstructured":"Inoue SFujita AShinoda K, et al. A case of intracranial vertebral artery dissection undetected by CT, MRI, and MRA at the onset of headache that caused subarachnoid hemorrhage seven days later. J Neuroendovascular Ther. 2022;16(5):265-269."},{"issue":"4","key":"bib5","series-title":"Neurosurgery","first-page":"930","article-title":"Management of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage","volume":"51","author":"Naito","year":"2002","unstructured":"Naito IIwai TSasaki T. Management of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage. Neurosurgery. 2002;51(4):930-937."},{"issue":"6","key":"bib6","series-title":"Lancet Neurol","first-page":"640","article-title":"Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection","volume":"14","author":"Debette","year":"2015","unstructured":"Debette SCompter ALabeyrie MA, et al. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol. 2015;14(6):640-654."},{"issue":"5","key":"bib7","series-title":"Neurosurgery","first-page":"1085","article-title":"Strategy for treating unruptured vertebral artery dissecting aneurysms","volume":"69","author":"Kai","year":"2011","unstructured":"Kai YNishi TWatanabe M, et al. Strategy for treating unruptured vertebral artery dissecting aneurysms. 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J Neurosurg. 1996;84(6):962-971."},{"issue":"4","key":"bib2","series-title":"Surg Cereb Stroke (Jpn).","first-page":"252","article-title":"A nationwide study of intracranial arterial dissection in the vertebrobasilar system (part 2): outcomes in hemorrhagic-onset cases","volume":"43","author":"Tajima","year":"2015","unstructured":"Tajima YOno JIHiguchi YMachida TSaeki NYamaura A. A nationwide study of intracranial arterial dissection in the vertebrobasilar system (part 2): outcomes in hemorrhagic-onset cases. Surg Cereb Stroke (Jpn).2015;43(4):252-256."},{"issue":"4","key":"bib3","series-title":"J Neurosurg","first-page":"1037","article-title":"Natural course of intracranial arterial dissections: clinical article.","volume":"114","author":"Mizutani","year":"2011","unstructured":"Mizutani T. Natural course of intracranial arterial dissections: clinical article.J Neurosurg. 2011;114(4):1037-1044."},{"issue":"5","key":"bib4","series-title":"J Neuroendovascular Ther","first-page":"265","article-title":"A case of intracranial vertebral artery dissection undetected by CT, MRI, and MRA at the onset of headache that caused subarachnoid hemorrhage seven days later","volume":"16","author":"Inoue","year":"2022","unstructured":"Inoue SFujita AShinoda K, et al. A case of intracranial vertebral artery dissection undetected by CT, MRI, and MRA at the onset of headache that caused subarachnoid hemorrhage seven days later. J Neuroendovascular Ther. 2022;16(5):265-269."},{"issue":"4","key":"bib5","series-title":"Neurosurgery","first-page":"930","article-title":"Management of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage","volume":"51","author":"Naito","year":"2002","unstructured":"Naito IIwai TSasaki T. Management of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage. Neurosurgery. 2002;51(4):930-937."},{"issue":"6","key":"bib6","series-title":"Lancet Neurol","first-page":"640","article-title":"Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection","volume":"14","author":"Debette","year":"2015","unstructured":"Debette SCompter ALabeyrie MA, et al. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol. 2015;14(6):640-654."},{"issue":"5","key":"bib7","series-title":"Neurosurgery","first-page":"1085","article-title":"Strategy for treating unruptured vertebral artery dissecting aneurysms","volume":"69","author":"Kai","year":"2011","unstructured":"Kai YNishi TWatanabe M, et al. Strategy for treating unruptured vertebral artery dissecting aneurysms. 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AJNR Am J Neuroradiol. 2014;35(7):1371-1375."},{"issue":"6","key":"bib10","series-title":"J Neurosurg","first-page":"874","article-title":"A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery","volume":"75","author":"Sasaki","year":"1991","unstructured":"Sasaki OOgawa HKoike TKoizumi TTanaka R. A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg. 1991;75(6):874-882."},{"issue":"4","key":"bib11","series-title":"No Shinkei Geka","first-page":"305","article-title":"Clinical features of unruptured vertebral artery dissection presenting as isolated occipital headache and\/or neck pain","volume":"41","author":"Echigo","year":"2013","unstructured":"Echigo TMatsui HOka H, et al. Clinical features of unruptured vertebral artery dissection presenting as isolated occipital headache and\/or neck pain. Article in Japanese. No Shinkei Geka. 2013;41(4):305-310."},{"issue":"9","key":"bib12","series-title":"Stroke","first-page":"2605","article-title":"Antiplatelets versus anticoagulation in cervical artery dissection","volume":"38","author":"Engelter","year":"2007","unstructured":"Engelter STBrandt TDebette S, et al. Antiplatelets versus anticoagulation in cervical artery dissection. Stroke. 2007;38(9):2605-2611."},{"issue":"6","key":"bib13","series-title":"Stroke","first-page":"1837","article-title":"Prognosis and safety of anticoagulation in intracranial artery dissections in adults","volume":"38","author":"Metso","year":"2007","unstructured":"Metso TMMetso AJHelenius J, et al. Prognosis and safety of anticoagulation in intracranial artery dissections in adults. 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