Disclosures: John A. Stratton, MD: No financial relationships or conflicts of interest
Case Description: This patient is a 39 year old female with Ehlers Danlos syndrome, rheumatoid arthritis, and asthma who initially presented to the acute hospital reporting left sided neck pain, dizziness, vertigo, left sided weakness, and difficulty swallowing. All of these symptoms reportedly started suddenly after she had been coughing.
Setting: Inpatient acute rehab hospital
Patient: A 39 year old female with Ehlers Danlos syndrome who developed sudden onset neck pain, dizziness, vertigo, difficulty swallowing, and left sided weakness after coughing. Assessment/
Results: On presentation to the emergency department MRI showed left cerebellar and medullary ischemia. CTA of the head and neck showed a left vertebral artery dissection. She was started on anticoagulation for her dissection and was admitted to the hospital for frequent neuro checks and remained on IV anticoagulation until her swallowing improved enough to be able to take oral medications. Once she was stabilized she was transitioned to acute rehab to work on her ambulation, balance, swallowing, and deficits in self-care. She experienced significant vertigo, nausea, vomiting, and double vision as a result of her stroke, however with medications for symptom management and glasses prescribed by neuro-optometry her symptoms were able to be controlled. Once her symptoms were controlled she progressed well with therapy, and was ultimately able to ambulate by the time of discharge.
Discussion: Ehlers Danlos syndrome is a risk factor for artery dissection, however it is less commonly reported in the vertebral artery, and there are very few cases of dissection reported that were attributed to coughing. These patients can be very symptomatic, but also have potential for significant recovery.
Conclusion: Patients with Ehlers Danlos syndrome can have an unusual etiology of their stroke and should be aware of what symptoms should prompt them to seek medical attention.
Level of Evidence: Level V
To cite this abstract in AMA style:
Stratton JA, Malhotra R. A Cough That Became a Medullary and Cerebellar Infarction: A Case Report [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/a-cough-that-became-a-medullary-and-cerebellar-infarction-a-case-report/. Accessed May 7, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-cough-that-became-a-medullary-and-cerebellar-infarction-a-case-report/