The typical presentation of VAD is a young person with
severe occipital headache and posterior nuchal pain
following a recent, relatively minor, head or neck injury.
The trauma is generally from a trivial mechanism but
is associated with some degree of cervical distortion.
Focal neurologic signs attributable to ischemia of
the brain stem or cerebellum ultimately develop in 85%
of patients; however, a latent period as long as 3 days
between the onset of pain and the development of CNS
sequelae is not uncommon. Delays of weeks and years
also have been reported. Many patients present only
at the onset of neurologic symptoms.
When neurologic dysfunction does occur, patients most
commonly report symptoms attributable to lateral medullary
dysfunction (ie, Wallenberg syndrome).
1) Patient history may include the following:
Ipsilateral facial dysesthesia (pain and numbness)
- Most common symptom
Dysarthria or hoarseness (cranial nerves [CN] IX
and X)
Contralateral loss of pain and temperature sensation
in the trunk and limbs
Ipsilateral loss of taste (nucleus and tractus
solitarius)
Hiccups
Vertigo
Nausea and vomiting
Diplopia or oscillopsia (image movement experienced
with head motion)
Dysphagia (CN IX and X)
Disequilibrium
Unilateral hearing loss
2) Rarely, patients may manifest the following symptoms
of a medial medullary syndrome:
Contralateral weakness or paralysis (pyramidal tract)
