Cervical Arterial Dissection

Beletsky, Vadim; Nadareishvili, Zurab; Lynch, John; Shuaib, Ashfaq; Woolfenden, Andrew R.; Norris, John W.

doi:10.1161/01.str.0000098649.39767.bc

Cited by 234 publications

(103 citation statements)

References 39 publications

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“…As no reliable data from randomized trials were available, it is not possible to draw any definite conclusions. 4,37 Reported nonrandomized studies, likewise, have not shown evidence of a significant difference between anticoagulants and antiplatelets.…”

Section: Management Optionsmentioning

confidence: 99%

“…7 This incidence appears to be significantly different from the 10.4% annual recurrence rate reported in adults. 4 The type of antithrombotic therapy (heparin, warfarin, or antiplatelet) and its duration are controversial. Thus, there is no evidence that anticoagulation is superior to observation or antiplatelet therapy in children.…”

Section: Management Optionsmentioning

confidence: 99%

“…Although none of the reported pediatric cases has been treated using an endovascular procedure, it is likely that, as experience with this technique (from the treatment of adult patients or of other similar conditions 4,9,40 ) increases, such reports will be available in the near future.…”

Section: Management Optionsmentioning

confidence: 99%

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Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Chamoun

Mawad

Whitehead

et al. 2008

PED

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Object Currently, no diagnostic or treatment standards exist for extracranial carotid artery dissection (CAD) in children after trauma. The purpose of this study was to review and describe the characteristics, diagnosis, and treatment of this rather uncommon sequelae of pediatric trauma. Methods A systematic review of the literature was performed to examine the pertinent studies of traumatic extracranial carotid artery (CA) injuries in children. Results No randomized trials were identified; however, 19 case reports or small case series consisting of 34 pediatric patients were found in the literature. The diagnosis of CAD was made in 33 of 34 patients only after the onset of ischemic symptomatology. Twenty-four of 34 patients underwent cerebral angiography to confirm diagnosis; MR angiography affirmed the diagnosis in 6 of 34 patients. There was little published experience with CA ultrasonography or CT angiography for diagnosis. Thirty of 34 patients were treated with medical therapy or observation; 2 of 4 patients treated with observation alone died. There was little experience with open surgical treatment of CAD in the pediatric population, and there were no studies on the endovascular treatment of traumatic CAD in children. The literature does not support anticoagulation therapy over antiplatelet therapy. Conclusions As a result of this review of the literature, the authors propose the algorithms for the evaluation and treatment of traumatic extracranial CADs in children. These recommendations include utilizing MR angiography as a screening tool in cases in which the clinical suspicion of CAD is high, using conventional cerebral angiography to confirm the diagnosis, implementing antiplatelet therapy as initial medical management, and reserving endovascular stenting in cases of failed medical treatment.

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Section: Management Optionsmentioning

confidence: 99%

Section: Management Optionsmentioning

confidence: 99%

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Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Chamoun

Mawad

Whitehead

et al. 2008

PED

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“…10 It has been found that the combined recurrence of stroke and death after successful treatment of cervical artery dissection causing stroke is 10-15 per cent. 16 There are no current figures available on the mortality or recurrence of stroke following thoracic aortic dissection.…”

Section: Arterial Dissection and Strokementioning

confidence: 99%

Pathophysiology and treatment of arterial dissection and stroke

Khanna¹,

Richard²

2007

Prog Neurol Psychiatry

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Although arterial dissection accounts for just 2.5 per cent of all strokes, 1 it is the commonest cause of this extremely disabling condition in people under 45 years of age. 2 Awareness of the link between dissection and stroke has been limited to date, especially when the cause is dissection of the thoracic aorta. This article provides an update on the accepted principles and more controversial issues surrounding the subject, illustrated with three clinical case studies. EpidemiologyIn patients under 45 years of age, 20-25 per cent of strokes are caused by arterial dissection. 2 The most common arteries to dissect and cause stroke are the cervical arteries, with an annual incidence of diagnosed dissection in these arteries of about 2.6-3 per 100 000 (of the population?). 2 Of the cervical arteries, dissection is more common in the carotid than in the vertebral arter y and there is also a higher incidence extracranially than intracranially. 1 The annual incidence of thoracic aortic dissection is similar to that of the cervical arteries, but only 3-5 per cent of patients with these dissections encounter neurological symptoms consistent with a stroke. Lifestyle risk factors for arterial dissection include smoking and the oral contraceptive pill, while organic risk factors include coronary artery disease, fibromuscular dysplasia, migraine and hypertension. 3 AetiologyDissections occur in weakened areas of a vessel wall. They can be spontaneous or can occur as a result of a trauma as simple as turning the neck. 4,5 However, the differentiation between spontaneous and traumatic dissections is ar tificial because of a continuum between both forms. It is better to define conditions as predisposing factors rather than true causes as the pathophysiology of stroke and dissection is relatively unknown (see Table 1). PathophysiologyAn arterial dissection is initiated by a tear in the intimal lining of a vessel. Due to high pressure, blood penetrates the endothelial cells of the tunica intima and penetrates the media layer. 6 Propagation of the tear along the length of the vessel now occurs along a specific line of cleavage, creating a false lumen and leading to stenosis or occlusion of the true lumen, often with thrombus formation at the site of dissection. 6 If the dissection is subadventitial, a pseudoaneurysm may form.Although the pathophysiology of dissection causing stroke is still unclear, two mechanisms have been suggested. 6 These mechanisms are linked. First, cerebral ischaemia may arise haemodynamically as a direct result of true lumen narrowing/occlusion by a thrombus at the dissection site, and second, stroke may occur due to the 'firing off' of microemboli from this thrombus. 6 It may be that these mechanisms are more or less likely depending on the arter y involved. Some evidence has suppor ted the microembolic mechanism as the pathophysiology behind cer vical arter y dissection and stroke. 7,8 However, there is little evidence that this is the dominant mechanism when the thoracic aorta is involved.Ver y few ...

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“…[1][2][3][4] It is estimated that 1 to 1.5 per 100 000 individuals in the United States will experience this condition. 5,6 Common presenting symptoms are headache and neck pain; thus, many of these patients may present for chiropractic care.…”

Section: Introductionmentioning

confidence: 99%

Vertebral artery dissection in a patient practicing self-manipulation of the neck

Mosby

Duray

2011

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe a patient who regularly practiced self-manipulation of her neck who presented with shoulder and neck pain and was undergoing a vertebral artery dissection. Clinical Features: A 42-year-old female patient sought care for left shoulder pain with a secondary complaint of left lower neck pain. Twelve days prior, she had had "the worst headache of her life," which began in her left lower cervical spine and extended to her left temporal region. The pain was sudden and severe, was described as sharp and burning, and lasted 3 hours. She reported nausea, vomiting, and blurred vision. Intervention and Outcome: Initial history and examination suggested that the patient's head and neck pain was not musculoskeletal in origin, but vascular. She repeatedly requested that an adjustment be performed, but instead was referred to the local emergency department for further evaluation. Magnetic resonance angiogram revealed a dissection of the left vertebral artery from C6 to the C2-C3 interspace and a 3-mm dissecting pseudoaneurysm at the C3 level. She underwent stent-assisted percutaneous transluminal angioplasty combined with antiplatelet therapy (clopidogrel) and experienced a good outcome. Conclusion: This case suggests that careful history taking and awareness of the symptoms of VAD are necessary in cases of sudden head and neck pain. More research is needed on the relationship between vertebral artery dissection and self-manipulation of the neck.

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Cervical Arterial Dissection

Cited by 234 publications

References 39 publications

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Pathophysiology and treatment of arterial dissection and stroke

Vertebral artery dissection in a patient practicing self-manipulation of the neck

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