Spontaneous dissection of the extracranial vertebral artery with spinal subarachnoid haemorrhage in a patient with Behçet's disease

A 40-year-old man with known definite Behçet's disease (BD) was admitted with confusional state which had started 4 days before admission with an acute headache and vomiting. Neurological examination revealed confusion, stiff neck, right facial weakness, left hemiparesis, dysartria and truncal ataxia. CSF was haemorrhagic and xanthochromic. Cranial CT scans were negative, but MRI showed a right pontine hyperintense lesion on T2-weighted images. Bilateral carotid angiograms were normal. Right vertebral angiogram showed findings consistent with a dissection at the V₂ segment of the artery. At the level of the fifth cervical vertebra, a radiculomedullary branch of the vertebral artery with an ancurysmal dilatation in its intradural portion was notable. This case shows that, in BD, aneurysn formation can also occur in a spinal artery and spontaneous vertebral artery dissection can be seen.