{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T10:09:18Z","timestamp":1783937358775,"version":"3.55.0"},"reference-count":19,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Marfan syndrome (MFS) is an autosomal-dominant connective-tissue disorder caused by pathogenic FBN1 variants. Aortic-root dilation and dissection are the canonical complications, whereas spontaneous vertebral artery dissection (VAD) is described only sporadically. Yet, cerebrovascular events are several-fold more common in MFS, and up to 74% of patients exhibit increased vertebral artery tortuosity, a validated predictor of dissection; Case Presentation: A 32-year-old African man with hypertension, type 2 diabetes mellitus, tobacco use, and headaches labelled as migraine presented with acute agitation, visual disturbance, vertigo, dysarthria, and right-sided weakness of two hours\u2019 duration. Examination disclosed previously unrecognised marfanoid stigmata: arachnodactyly with positive wrist and thumb signs, reduced upper-to-lower segment ratio, increased arm-span-to-height ratio, dolichocephaly, pectus excavatum, and a high-arched palate. Non-contrast CT showed left occipital and posterior inferior cerebellar hypodensities. CT angiography demonstrated discontinuous intraluminal filling defects in the left vertebral artery at C4 and C2, and MR angiography confirmed long-segment occlusion\/stenosis of the intracranial left vertebral artery. Echocardiography revealed mild aortic-root dilation (4.0 cm; Z-score +2.53) and a small patent foramen ovale (PFO) with a positive bubble study. The patient received intravenous thrombolysis followed by antiplatelet therapy, a high-intensity statin, antihypertensive therapy, and intensified glycaemic control. Because the infarct territory matched the dissected vessel and the small PFO carried no high-risk features (RoPE score 6; PASCAL category \u201cunlikely\u201d), VAD was designated the culprit lesion and the PFO incidental; Conclusions: Spontaneous VAD may be the inaugural manifestation of unrecognised MFS, antedating aortic complications. In young adults with cryptogenic posterior-circulation stroke and marfanoid features, early cervical imaging and Ghent assessment are warranted, and a coexistent PFO should not be assumed causal. Multidisciplinary evaluation supports accurate attribution and surveillance.<\/jats:p>","DOI":"10.3390\/reports9030223","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T08:53:58Z","timestamp":1783932838000},"page":"223","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Spontaneous Vertebral Artery Dissection as the Heralding Manifestation of Previously Undiagnosed Marfan Syndrome in a Young Adult with Posterior Circulation Stroke: A Case Report"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2126-8632","authenticated-orcid":false,"given":"Alawi M.","family":"Alkhadrawi","sequence":"first","affiliation":[{"name":"Cardiac Center, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al Khobar 31952, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2625-9436","authenticated-orcid":false,"given":"Jawaher","family":"Saad","sequence":"additional","affiliation":[{"name":"College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arwa","family":"Alsaleem","sequence":"additional","affiliation":[{"name":"College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9807-4870","authenticated-orcid":false,"given":"Mohammed","family":"Al-Hariri","sequence":"additional","affiliation":[{"name":"Department of Physiology, Collage of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3433-4458","authenticated-orcid":false,"given":"Fayez","family":"Alzubair","sequence":"additional","affiliation":[{"name":"College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia"},{"name":"Heart Health Center, King Saud Medical City, Riyadh 11196, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1038\/352337a0","article-title":"Marfan Syndrome Caused by a Recurrent de Novo Missense Mutation in the Fibrillin Gene","volume":"352","author":"Dietz","year":"1991","journal-title":"Nature"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1136\/jmg.2009.072785","article-title":"The Revised Ghent Nosology for the Marfan Syndrome","volume":"47","author":"Loeys","year":"2010","journal-title":"J. Med. Genet."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1161\/CIRCULATIONAHA.110.990549","article-title":"Increased Vertebral Artery Tortuosity Index Is Associated with Adverse Outcomes in Children and Young Adults with Connective Tissue Disorders","volume":"124","author":"Morris","year":"2011","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Gunduz, M.E., Kadirvel, R., Kallmes, D.F., Pezzini, A., and Keser, Z. (2023). Spontaneous Cervical Artery Dissection: Is It Really a Connective Tissue Disease? A Comprehensive Review. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1241084"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.jstrokecerebrovasdis.2017.08.036","article-title":"Increased Prevalence of Cerebrovascular Disease in Hospitalized Patients with Marfan Syndrome","volume":"27","author":"Kim","year":"2018","journal-title":"J. Stroke Cerebrovasc. 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Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1916","DOI":"10.3174\/ajnr.A6732","article-title":"Intracranial Arterial Tortuosity in Marfan Syndrome and Loeys-Dietz Syndrome: Tortuosity Index Evaluation Is Useful in the Differential Diagnosis","volume":"41","author":"Spinardi","year":"2020","journal-title":"Am. J. Neuroradiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e63467","DOI":"10.1002\/ajmg.a.63467","article-title":"Vertebral Artery Dissection Caused by Atlantoaxial Dislocation in a Patient with Marfan Syndrome","volume":"194","author":"Vornetti","year":"2024","journal-title":"Am. J. Med. Genet. 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