To evaluate the clinical and imaging characteristics of vertebral-basilar dissection aneurysm (VBDA).

A retrospective review of 57 cases of VBDA patients between Jan 2008 and Mar 2014 in our hospital was performed. The clinical manifestation, the DSA findings, positive CT/MRI and CTA/MRA results was analyzed.

Hemorrhagic stroke was identified in 28 cases (49.1%), ischemic stroke in 20 cases (35.1%), cervical occipital neuralgia in 5 cases (8.8%), asymptomatic in 4 cases (7%). The most common clinical symptoms were headache (59.6%), nausea and vomiting (54.4%), dizziness (42.1%), cervical occipital pain (26.3%). Diagnosis was confirmed by DSA in 55 cases among 55 cases, by CTA in 7 among 33 cases, by MRA in 1 among 8 cases; by high resolution MR in 4 among 4 cases. The most common sign of DSA, CTA and MRA is bead syndrome (67.3%) and rat tail sign (25.5%). The most common type is the saccular aneurysms, with fusiform aneurysm and parent artery abnormal thickening as less common signs.

SAH is the most common onset syndrome of VBDA, while other common clinical signs include post-circulation ischemia or infarction. DSA is the most valuable imaging exam for VBDA, and high resolution MRA is a diagnostic method with great potential.