Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis

Bray, J. M. De; Pénisson-Besnier, I.; Dubas, Frédéric; Emile, J.

doi:10.1136/jnnp.63.1.46

Cited by 145 publications

(140 citation statements)

References 22 publications

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“…7,22,26 In our present study, 3 patients showed Ն2 attacks with neurological deficit within 1 month to 12 years, and some patients complained of repeated symptoms, such as vertigo and headache. These attacks and repeated symptoms may have resulted from the aforementioned dynamic condition of vertebrobasilar artery dissection; however, it is possible that they were due to recurrent arterial dissection.…”

Section: Treatment and Outcomementioning

confidence: 94%

“…Some recent studies indicate the possibility of establishing the diagnosis of extracranial arterial dissection with the use of ultrasound, 26 helical CT, 27 and MR angiography. 14,15 However, the ultrasound technique does not have diagnostic value for intracranial arteries, and helical CT is also less reliable for detecting abnormality in the posterior fossa because of many artifacts.…”

Section: Vascular Imagingmentioning

confidence: 99%

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Clinical and Neuroradiological Features of Intracranial Vertebrobasilar Artery Dissection

Hosoya

Adachi

Yamaguchi

et al. 1999

Stroke

208

172

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Background and Purpose-We sought to determine the clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. Methods-The clinical features and MR findings of 31 patients (20 men and 11 women) with intracranial vertebrobasilar artery dissections confirmed by vertebral angiography were analyzed retrospectively. The vertebral angiography revealed the double lumen sign in 11 patients (13 arteries) and the pearl and string sign in 20 patients (28 arteries). Results-The patients ranged in age from 25 to 82 years (mean, 54.8 years). Clinical symptoms due to ischemic cerebellar and/or brain stem lesions were common, but in 3 cases the dissections were discovered incidentally while an unrelated disorder was investigated. Headache, which has been emphasized as the only specific clinical sign of vertebrobasilar artery dissection, was found in 55% of the patients. Intramural hematoma on T1-weighted images has been emphasized as a specific MR finding. The positive rate of intramural hematoma was 32%. Double lumen on 3-dimensional (3-D) spoiled gradient-recalled acquisition (SPGR) images after the injection of contrast medium was identified in 87% of the patients. The 3-D SPGR imaging method is considered useful for the screening of vertebrobasilar artery dissection. Conclusions-Intracranial vertebrobasilar artery dissection is probably much more frequent than previously considered.Such patients may present no or only minor symptoms. Neuroradiological screening for posterior circulation requires MR examinations, including contrast-enhanced 3-D SPGR. Angiography may be necessary for the definite diagnosis of intracranial vertebrobasilar artery dissection because the sensitivity of the finding of intramural hematoma is not satisfactory.

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Section: Treatment and Outcomementioning

confidence: 94%

Section: Vascular Imagingmentioning

confidence: 99%

Clinical and Neuroradiological Features of Intracranial Vertebrobasilar Artery Dissection

Hosoya

Adachi

Yamaguchi

et al. 1999

Stroke

208

172

View full text Add to dashboard Cite

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“…10 The use of ultrasonographic techniques in the initial assessment of patients with suspected dissection has invariably required confirmatory testing with additional angiography, either invasively or noninvasively. The technique is dependent on the accessibility of the region to screening and although helpful for proximal dissections, the detection of more distal disease is limited 11,12 Controversy continues as to the optimal management of patients with asymptomatic vertebral artery injury. Guidelines published in 2002 indicated that there was insufficient evidence to support anticoagulation in asymptomatic patients, specifically relating to a 14% risk of complications from anticoagulant use.…”

Section: Discussionmentioning

confidence: 99%

Blunt cervical spine trauma as a cause of spinal cord injury and delayed cortical blindness

et al. 2006

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“…CT angiography and MRA appear to have similar specificities and sensitivities; however, MRA allows both luminal narrowing and thrombus to be seen in addition to the characteristic appearances such as 'string sign', pseudoaneurysm, double lumen or an intimal flap. 11,12 The preferred imaging techniques for a thoracic aortic dissection in the acute setting are spiral CT, transoesophageal echocardiography (TOE), MRI or conventional CT for haemodynamically stable patients. TOE is less sensitive and specific than spiral CT or MRI, and TOE is operator-dependent.…”

Section: Diagnosismentioning

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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Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis

Cited by 145 publications

References 22 publications

Clinical and Neuroradiological Features of Intracranial Vertebrobasilar Artery Dissection

Clinical and Neuroradiological Features of Intracranial Vertebrobasilar Artery Dissection

Blunt cervical spine trauma as a cause of spinal cord injury and delayed cortical blindness

Pathophysiology and treatment of arterial dissection and stroke

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