The physical examination of patients who have not yet
manifested neurologic dysfunction may be misleading.
The occipital and nuchal pain associated with VAD mimics
musculoskeletal pain and often is attributed to the
mechanical strain that precipitated the dissection.
1) Depending upon which areas of the brain stem or cerebellum
are experiencing ischemia, the following signs may be
present:
Limb or truncal ataxia
Nystagmus
Ipsilateral Horner syndrome in as many as one third
of patients with VAD (ie, impairment of descending
sympathetic tract)
Ipsilateral hypogeusia or ageusia (ie, diminished
or absent sense of taste)
Ipsilateral impairment of fine touch and proprioception
Contralateral impairment of pain and thermal sensation
in the extremities (ie, spinothalamic tract) \
Lateral medullary syndrom
2) Cerebellar findings may include the following:
Nystagmus
Medial medullary syndrome
Tongue deviation to the side of the lesion (impairment
of CN XII)
Contralateral hemiparesis
Ipsilateral impairment of fine touch and proprioception
(nucleus gracilis)
Internuclear ophthalmoplegia (lesion of the medial
longitudinal fasciculus)
