J Clin Neurol.  2018 Jul;14(3):428-429. 10.3988/jcn.2018.14.3.428.

Crab Sign in Bilateral Extracranial Vertebral Artery Dissection

Affiliations
  • 1Department of Neurology and Stroke Center, University Hospital Basel, Basel, Switzerland. nils.peters@usb.ch
  • 2Neurorehabilitation Unit and University Center for Medicine of Aging and Rehabilitation, Felix Platter Hospital Basel, University of Basel, Basel, Switzerland.

Abstract

No abstract available.


MeSH Terms

Vertebral Artery Dissection*
Vertebral Artery*

Figure

  • Fig. 1 Crab sign in vertebral artery dissection. Diffusion-weighted MRI shows bilateral acute ischemic cerebellar infarction that is larger on the right side (A). Contrast-enhanced magnetic resonance angiography shows irregularities with narrowing of both distal vertebral arteries, more pronounced on the right side (B, red circle). Consistent with this, duplex sonography of the V3 segments of the vertebral arteries reveals an intramural hematoma (arrows) with luminal narrowing and consequential increase in flow velocity (PSV), which again is more pronounced on the right side (C). Axial T1-weighted fat-saturated MRI (D) confirms bilateral dissection of the distal extracranial vertebral arteries with an intramural hematoma, which strikingly resembles a crab as follows (E). a: dissected vertebral artery=eyes, b: upper cervical spinal cord=rostrum (carapace), c: obliquus capitis inferior muscle=propodus, d: posterior arch of atlas = mouth, e: rectus capitis posterior major muscle=fixed finger of cheliped, f: semispinalis capitis muscle=dactyl of cheliped. EDV: end diastolic velocity, MRI: magnetic resonance imaging, PSV: peak systolic velocity, RI: resistive index.


Reference

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