• Zhichao Li, Junni Liu, Xiang Wang, Xiaohui Liu, Qinjian Sun, Yifeng Du, and Ling Yin.
• Department of Oncology, The First Affiliated Hospital of Shandong First Medical University.
• Medicine (Baltimore). 2020 Oct 30; 99 (44): e22822.

IntroductionVertebral artery dissection (VAD) is a common cause of stroke in young and mid-aged adults without predisposing risk factors for vascular disease. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. Improved imaging techniques can be used to detect VAD, whose current treatment options are limited.Patient ConcernsThe patient presented with neck and shoulder pain for a week after sleeping against the wall with cervical proneness for 1 night. He had sudden headache, slurred speech, and left side weakness for 1.5 hours on admission.DiagnosisThe patient had VAD complicated by posterior circulation stroke.InterventionsAcute stroke was treated with intravenous thrombolytic therapy. Then, the patient was administered follow-up anticoagulants.OutcomesThe patient's condition improved after thrombolytic therapy. He recovered well, with no recurrence during a 4-year follow-up.ConclusionVAD should be taken into consideration in differential diagnosis of posterior circulation stroke or transient ischemic attack in young patients. Intravenous thrombolytic therapy may be safe and effective for stroke-complicated cases. This case report demonstrates that expanded diagnostic protocol for acute ischemic stroke assures rapid and correct diagnosis.

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