Recovery progress after stroke and vertebral artery dissection

18 Replies

I have been meaning to provide an update on my recovery progress after suffering the vertebral artery dissection and stroke. I had another MRA (magnetic resonance angiogram) scan of my head and neck vasculature on January 30th, about eight weeks after the stroke and six weeks after beginning the anticoagulant therapy.

MRA results

The report I received from the radiologist who read/interpreted the MRA images stated that my vertebral artery had an “essentially normal appearing lumen” with no signs of the dissection from before. This is simply amazing to me that the dissected vertebral artery has healed completely.

While I’m overjoyed, I do need to await the consult with my neurologist to discuss the MRA report and determine what happens next in my treatment plan. That appointment is in about 10 days from today. My expectation is that I’ll still need one or more follow-up MRAs to watch for any potential issues with my vertebral arteries or cranial vasculature—just in case—and hopefully I can scale back or discontinue the anticoagulation therapy immediately.

Vertebral artery images: then and now

Below are images of my vertebral artery showing the dissection and narrowing of the lumen (left) as compared to the same after six weeks of anticoagulant therapy (right) showing a return to normal size and function.

Comparison MRAs showing vertebral artery dissection (left) and recovery (right)

 

And, below is the larger image of the latest MRA of the carotid and vertebral arteries with the right side showing signs of recovery.

My follow-up MRA showing recovery of right vertebral artery 8 weeks after dissection.

What now?

My primary doctor has cleared me for any activity I want to do including running, cycling, and other sports with the exception of anything at high altitudes (> 10,000 ft.) or at extreme pressure (scuba diving). I’m slowly getting back into my fitness/training regimen with an eye toward some ultra running goals later this year. With the recurrence possibility of this type of artery dissection and stroke slim to none, I intend to live life fully and demonstrate that exercise truly is the best medicine.

  • Kiera

    Thanks for posting. I had a dissection/stroke on March 17, 2012. I fond .extra comfort reading your post, OB top of the comfort God provides. I am going to tell my Neuro I want am MRA as well.

    • http://iamjolly.com/ Robert

      Kiera,

      How have you been doing lately? Hope all is well and your recovery has been good.

      -Robert

  • MC

    I just read your posts about your vertebral artery dissection and am finding hope. My husband is currently in ICU in our hometown, which luckily is home to a Level I Trauma Center and a Brain and Spine Institute. Our local ER had him CT scanned and transferred within hours of our coming in — it was continuous vomiting that sent us in within 20 minutes of the pain and the “thunderclap” headache — and within 9 hours, he’d had an angiogram and a preliminary diagnosis. A second angiogram yesterday revealed the dissection. Not the news we were hoping for.

    We are currently hoping that the tear will heal on its own as it’s located in a place that will be very risky to operate in. My husband developed hydrocephalus and currently has a catheter in to relieve the pressure, but his doctors are hoping to have that out very soon. Next week is a third angiogram and then we reevaluate what to do next based on the findings. Hopefully, we will find that the tear is healing nicely and no intervention will have to be done. If you read this, please keep us in your thoughts. And thank you for putting your experience out there. It’s a source of hope and comfort during this extremely difficult and stressful time.

    ~ M & M in Austin, TX

    • http://iamjolly.com/ Robert

      MC –

      My thoughts are with you and your husband right now. Everyone is different, but I hope with the right meds (likely anti-coagulants) your husband may recover without the need for more invasive treatments.

      Be well, and do keep me posted on how things are going.

      -Robert

  • Jv

    Hello,
    I have read your story and I must say God bless you! My husband had a right vertebral artery dissection (september 16th) he has not experienced any loss of motor skills, memory etc. The only symptom he has is lightheadedness. Given the many things the doctors said could have happened, we consider him “lucky”. The dissection spared his brain stem and the PICA area. His collateral arteries are making up for the loss thankfully. He is on coumadin and we will have a follow up mra in December, as this will mark the 3 month period. We are both so afraid of him having another stroke, or dissection on the other side. I have read that in some people it has happened. Its no way to live and time is really the only thing that will bring us comfort. But, how did you deal with this? Were you constantly afraid of it happening again? were you afraid to move naturally? Did your artery heal on its own, did you do anything other than the anti-coagulation therapy? I am sorry for al the questions but this is still new to us and we are still mostly in shock. We are hoping for the very same outcome that you experienced. But again, once it heals, did they want to put in a stent for safety purposes or are they satisfied that it healed and is no longer a threat to you?

    I know every case is different but I just thought I would inquire. Stay well and all the best to you.
    thanks-
    jv

    • http://iamjolly.com/ Robert

      Hi JV,

      Thanks for sharing your husband’s (and your) story. It sounds like he may have had an event eerily similar to mine. I didn’t experience lightheadedness, but I had pretty severe headaches daily for about six weeks post-stroke. My dissection was deemed “spontaneous” in that the doctors and I cannot determine any events or trauma that can be labeled as a cause for it. It may be due to a history of mild hypertension which caused stress on the artery that eventually tore, or it may just be genetics.

      I was afraid, for a while, that I might make the dissection worse and/or suffer another stroke. My doctors wanted me to be pretty conservative with my activities to reduce my risk of damaging the artery for about 3-4 months. They said, specifically, to avoid soccer or other impact sports, avoid skydiving, SCUBA diving, and mountaineering to avoid pressure changes which might affect the healing of the artery, and to be careful when biking and running. I only do the running and cycling thing, so I just took it easy and allowed myself some time to heal.

      After follow-up MRAs, I was cleared for all activity. I no longer am taking anti-coagulants, and I don’t live in constant fear. I take an aspirin a day along with a low-dose of medicine for my mild hypertension. My primary doctor says he doesn’t really know if those are 100% necessary, but no one is willing to cut me loose from those meds at this point! There were no stents or invasive procedures recommended, and I’m told I don’t have any more risk than anyone else at this point.

      As for getting back to normal, I definitely feel that way now. We had a baby over the summer (my stroke occurred about a month after we found out my wife was pregnant) and I plan to be around and healthy for my kids for a very long time! I’m back to cycling and running, although it’s been tough to get back into the rhythm and maintain a regular workout schedule. I do feel that maintaining fitness will be key to preventing another stroke and fending off other age-related maladies.

      I hope this gives you some positivity and that your husband’s recovery will be fast. I’ll be thinking of you all and please do keep in touch.

      -R

      • Marc Wouters

        Hi All,

        I had a dissection on August 7th 2012, followed by a stroke.
        All stroke symptoms dissapeared after 48 hours, except for extreme fatigue.
        I have been on Warfarin ever since and will be for another 4 weeks, then switching to Aspirin daily.
        I am 48 years old, I had been racing a bicycle for the last few years in national championships with guys halve my age and holding my own. With that knowledge the consultant has stopped all my cycling till end of january, I have replaced it with walking and gardening for now.
        My last MRI/MRA showed no significant blood flow through the artery but the tear is healing as expected.
        I hope to get back to my bike in February but wont race the coming season. I will concentrate on distance rather then speed for 2013. There is always 2014 ;-)
        I have had not a sympton since August 9th, no pain, no headache. A good bit of fatigue during the first few months but this has improved a lot.
        hope this helps……
        Marc

  • SUSA

    So sorry for your situation, but thankful you are doing so well. Happy to find your post.

    Female mid40′s -First week of October 2012 had severe bronchitis. While coughing had sudden SEVERE HEAD PAIN (maybe thunderclap but certainly not a headache). Screamed & cried 30 minutes to ER. CT showed nothing & sent home. 3 horrible weeks, 5 more incidents, 2 more ER visits & 3 dr visits. Right side of head & face numb, I kept insisting something was bad wrong but no one listened. All said to young for stroke, suposedly protocol doesn’t call for MRA-contrast in ER. Woke up with numbness on Left side. Finally had enough. Feeling little better & ready to fight for myself I went to Houston. Diagnosed with vertebral artery dissection (maybe from cough) & multiple vasculitis in brain. Now on meds & waiting for possible autoimmune diagnosis. Please listen to your body. You know you best. Sometimes you have to insist & Don’t be dismissed. You have to be your own health advocate. Don’t have blind faith in you health care providers. If you aren’t getting what you need – MOVE ON. I am so blessed to have made it to Houston. Things could have been so much worse. Still to early to tell what the future holds, but to hard headed to accept anything less than the best. Thanks for a sounding board. I soooooooooooo needed that. Hope it helps others.

  • Gregg

    I had a left vertebral artery dissection from an injury after going down a water slide in a mud run. Someone slammed into me at the bottom of the slide. No symptoms until 10 days later when I had a stroke.
    Recovered enough within 10 minutes to be able to get up off the floor and drive to the emergency room.
    They did a CT scan and did not see anything and dismissed it as vertigo. I was still partially blind in my left eye. Went to another hospital that evening and got an MRI and was admitted for a week. After my hospital stay …my energy level has decreased. I get headaches and pressure in my head. (never before this stroke) Stiff neck…so stiff it cracks when I turn my head. Sometimes I get a little dizzy and my vision a little blurry.
    The neurologist says it is completely crushed and no blood flow but arteries sometimes heal themselves.
    My question is there anything I can do besides taking Coumadin? Will light exercise tell my brain that it needs more blood and increase the chances of healing? Read that taking Niacin (not the no flush) will increase blood flow. Besides time and prayer…what else can I do?
    Gregg McElwee
    Laguna Hills, California

    • http://iamjolly.com/ Robert

      Hi Gregg,

      Thanks for sharing your experience. You’re fortunate you got the MRI to correctly diagnose the VAD & stroke. I had headaches daily for about four weeks after the stroke, then somewhat regularly (but not daily) for about two to three weeks after that. The good news is the headaches went away. I hope the same for you. I sometimes feel pain in my neck and wonder if it’s from my vertebral artery, but I tend to think I’m hypervigilant about any kind of strange or unpleasant feeling in my head or neck now. Your pain is almost certainly more real than mine (due from the trauma you suffered), so I would recommend speaking with your neurologist about that. Especially since you have dizziness and vision issues accompanying that pain.

      My artery has healed completely now. So, yes, these dissections can and do heal. The “gold standard” of treatment has been Coumadin/Warfarin therapy. I don’t know about nor can I recommend anything beyond that. I did start light exercise during my treatment – walking, then some running – with the awareness and blessing of my physicians (primary doc and neurologist). I am of the opinion that exercise is almost always a good thing for healing. But too much at the wrong time could be disastrous!

      My advice would be to keep speaking with your neurologist and other qualified medical providers and let them know your goals and any issues you’re having. It does take time, but it sounds like you were active (probably very much so) prior to the VAD and stroke. There’s no reason to think that you can’t return to full activity after allowing time for recovery. My thoughts are with you and your family. Thanks again for reaching out.

      -Robert

  • Kyle Poole

    Thanks for your posts Robert. Congrats on your recovery! I am 43, married, with two teenage sons, very healthy & active, & had a VAD on Sept. 6, 2012 that led to a stroke. Fortunately, the stroke was isolated in the cerebellum, the artery has “healed” and I have been back to “normal activity” since a few weeks after the stroke. I intially thought I had vertigo, got a shot for nausea and laid in the bed for 48 hours not realizing what was truly happening – even though I has a crushing headache. After the CT scan at the ER revealed the stroke, I was in ICU for a few days, had some therapy initially to regain balance & vision, and was on Warfarin for 3 months after the stroke. Folow-up MRA’s showed “healthy blood flow” and that the artery was healed (though they could “see where the VAD happened it now looks like an old injury that has healed.” (Praise God.) Now, I take an adult aspirin once a day, and run 9-12 miles a week at a pretty decent pace. Planning on a 10k in April to kind of “celebrate” the recovery. The docs cleared me for running pretty early on, but advised me to be careful with any contact sports, or sports where I would have to “whip my neck” quickly. They told me roller coasters were out forever :( I have some “dull neck pain” from time to time & occasional headaches in the back of my head – especially later in the day – I attribute these symptoms to ongoing healing from the VAD & stroke, and will go back for another visit with the neurologist this summer to check things out. I am extremely thankful for life & healing and want to encourage others who are recovering from VAD’s to stay positive and active – there are brighter days ahead!

    • http://iamjolly.com/ Robert

      Hello Kyle,

      Thanks for sharing your story. It’s so similar to mine, and I’m grateful for the confirmation that activity helps with the healing process. I hope all continues to go well for you and you’re able to do anything your sons can — with the possible exception of roller coasters!

      Robert

  • Susan

    My husband is currently recovering from a left vertebral dissection and stroke. He colapsed while standing at the sink doing dishes. He never lost consciousness. Extreme dizziness and headache, light sensitivity etc. Taken to ER. Ct was negative, ER dr starts taking about a bad migraine. Finally I said loudly…52 yr olds can have a stroke!are you equipped to handle this type of event here? “yes we are a stroke hospital”. Ok what other test can diagnose a stroke cuz I know CT scans don’t always show a stroke in 1st 24 hr. He finally ordered an MRI and that lead to a diagnoses of stroke. We got the diagnoses approximately 4-41/2 hours after onset of symptoms…does anyone know if TPA would help w the dissection type of vad…just curious if anyone was give that drug. My husband was in an ICU for 2 days w horrific headaches , then flown to a specialized neuro ICU due to brain swelling, stayed their another 7 nights. He was able to escape the drainage or brain surgery. He is now in a rehab hospital for another week. His main problem now is dizziness w standing. Hopefully things will get better.

    • http://iamjolly.com/ Robert

      Hello Susan,

      Thank you for sharing you and your husband’s story here. First, I’m glad he seems to be doing well. It sounds like he received (and continues to receive) the help he needed. He’s so fortunate that you spoke up and didn’t allow them to stop before fully ruling out a stroke. Bravo for you!

      Everyone should learn how to recognize stroke warning signs, and then speak up when something doesn’t seem right whether or not it’s convincing a loved one to get medical help or insisting on a comprehensive diagnostic approach from healthcare providers. Susan, you may have saved your husband’s life by challenging the doctor to order more than a CT. Luckily for me, my stroke was minor enough that I didn’t die as a result of my own experience with a missed diagnosis of “headache” after a CT in the ER.

      I am not qualified to answer your question about tPA and how it relates to treatment for a vertebral artery dissection. I do know that my neurologist said that Warfarin/Coumadin therapy was the “gold standard” in treatment for VAD, and that worked for me. It sounds like your husband is in good hands with his current neurologist(s), so I am sure they have a sense of what will be the most effective treatment plan to follow.

      My thoughts and well wishes are with you and your husband, Susan. Please do keep me updated. I’m optimistic that the worst is behind you both now.

      -Robert

  • Jane

    I am 28 and has a vertebral dissection and stroke after a skiing injury. I fell hard and hit my head and had concussion. I recovered quickly and got back to normal activities, then 10 days after I had severe vomiting, vertigo, and double vision. After an MRI i was diagnosed with a stroke. It’s 7 weeks after my stroke now and I am much better now. My balance is back to normal, but unfortunately I still have some double vision. My neurologist says this will go away gradually. I just wanted to share my story with you all and wish you all the best.

    • http://iamjolly.com/ Robert

      Wow, Jane! Thanks for sharing your experience here. I’m glad to hear you’re doing better, and I hope you enjoy a full, quick recovery which allows you to return to being as active as you want. It certainly sounds like that will happen!

  • Paul

    Hello Robert,

    I love this blog. I am a physical therapist and have a patient that was recently diagnosed with a VAD. The first one in 15 years of practice. One thing I cannot find in your blog was your original symptoms. What were the preceding indications of your problem or those of your other posters? I know the text book symptoms but curious what you went thru.

    • http://iamjolly.com/ Robert

      Hello Paul,

      Thanks for finding this and for your comment. What happened with me, in terms of initial symptoms, was a sudden onset of severe headache, nausea, and loss of balance. There was no buildup of pain or discomfort in my neck or head—it came on without warning. My neurologist called it a case of spontaneous vertebral artery dissection (sVAD), as I had no history of trauma or genetic risk factors or any other events which could be blamed for the VAD.

      I did have some mild hypertension prior to the VAD, and that could be a contributing factor. The stress that the arterial walls were subjected to, over time may have weakened them. However, there’s no way to know for sure. I was very active prior to the VAD and stroke, and my health was off-the-charts excellent. My resting heart rate at time of VAD was in the low 40s, so the mild HTN was the only issue which may have impacted me.

      I hope this helps, but do let me know if you want to explore this further. I’m borderline evangelical about the role of exercise and fitness in recovery from brain injury (and any injury for that matter). :)

      -R