Cervical arterial dissection: clinical characteristics in a neurology service in São Paulo, Brazil

Abstract

Cervical arterial dissection accounts for only a small proportion of ischemic stroke but arouses scientific interest due to its wide clinical variability. Objective: This study aimed to evaluate its risk factors, outline its clinical characteristics, compare treatment with antiaggregation or anticoagulation, and explore the prognosis of patients with cervical arterial dissection. Methods: An observational, retrospective study using data from medical records on patients with cervical arterial dissection between January 2010 and August 2015. Results: The total number of patients was 41. The patients' ages ranged from 19 to 75 years, with an average of 44.5 years. The most common risk factor was smoking. Antiaggregation was used in the majority of patients (65.5%); 43% of all patients recanalized in six months, more frequently in patients who had received anticoagulation (p = 0.04). Conclusion: The presence of atherosclerotic disease is considered rare in patients with cervical arterial dissection; however, our study found a high frequency of hypertension, smoking and dyslipidemia. The choice of antithrombotic remains controversial and will depend on the judgment of the medical professional; the clinical results with anticoagulation or antiaggregation were similar but there was more recanalization in the group treated with anticoagulation; its course was favorable in both situations. The recurrence of cervical arterial dissection and stroke is considered a rare event and its course is favorable.

Presentation of cerebral and cervical arterial dissections in Botucatu, Brazil: case series

“…Cerebral and cervical artery dissection are important causes of stroke, especially for people under 45 years, where they may be responsible for approximately onefifth of all cases. [5][6][7] The mean patient age in our case series was 55 years (range, 16-85), and these findings are probably related due to the selection criteria used for this study. All patients in our institution underwent CTA in the acute stroke phase and were only sent to the angiography suite when there were complications or the diagnosis was dubious.…”

“…1,2 Spontaneous dissection of the carotid and vertebral arteries is responsible for 2% of all ischemic strokes, with higher occurrence in young people, 3,4 affecting their most productive years. [5][6][7][8] The most common risk factors include arterial hypertension, smoking, dyslipidemia, fibromuscular dysplasia, collagen disorders, trauma, and migraine with aura. 3,7,[9][10][11] Sudden onset neck pain associated with nausea, vomiting, and signs of neurological deficits are strong indicators of cervical artery dissection.…”

“…10 Although the clinical presentation may indicate a serious condition such as stroke or subarachnoid hemorrhage (SAH), prognosis and recovery are typically positive and most patients achieve functional independence. [5][6][7] In addition, the incidence of recurrent stroke in these patients is usually low. 12 Diagnosis of cervical or vertebral dissection is based on a combination of clinical and radiological findings.…”

Role of CEUS in Vascular Pathology

“…Die zervikale arterielle Dissektion ist nicht die Hauptursache für einen ischämischen Schlaganfall; bei jüngeren Erwachsenen ist sie jedoch für 20-25 % der Fälle verantwortlich, mit einem Inzidenzgipfel um das 40. Lebensjahr [15][16][17] (▶ Abb. 1-4).…”

“…In particular, "soft" lipid-rich plaque, extensive disease (15 mm or more), a pre-occlusive lesion, and circumferential extensive calcification increase the risk of cerebro-vascular events after carotid artery stenting [13,14]. Cervical arterial dissection is not a major cause of ischemic stroke, but among younger adults it accounts for 20-25 % of cases with a peak of incidence around the age of 40 [15][16][17] (▶ Fig. 1-4).…”