Bilateral thalamic infarction after traumatic vertebral artery dissection.

A 29-year-old female patient visited the emergency room for whirling dizziness and hypersomnolence. She had had a cervical chiropractic manipulation two weeks before admission. She had no previous history of stroke or vasculitis. Initial diffusionweighted images showed diffusion restriction in the bilateral thalami, occipital lobes, and brain stem. Subsequent magnetic resonance angiography (MRA) and source images of time of flight (TOF) MRA demonstrated luminal irregularities of the bilateral vertebral arteries and intramural hematoma on the wall of right vertebral artery. Catheter angiography showed an artery of Percheron. This case acknowledges that anatomic variation and a patient’s history leads to the correct diagnosis. DISCUSSION