Head Pain in Non-Traumatic Carotid Artery Dissection: A Series of 65 Patients

Biousse, Valérie; d'Anglejan-Chatillon, Jacques; Massiou, H.; Bousser, M. G.

doi:10.1046/j.1468-2982.1994.1401033.x

Cited by 190 publications

(118 citation statements)

References 10 publications

(28 reference statements)

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“…This agrees with previous studies [4][5][6][7][8]. In ICAD patients, pain was significantly more frequent in the anterior part of the head, compared to VAD, where pain occurred in the nuchal and/or occipital region.…”

Section: Discussionsupporting

confidence: 92%

“…The exact mechanism is unknown. In 65 patients with ICAD, it was observed that previous history of migraine was more frequent in patients with painful dissection than in patients with non-painful dissection [4]. In this study, SCAD-related pain was defined as any pain that occurred before, during or after the IE.…”

Section: Discussionmentioning

confidence: 94%

“…Headache, facial or neck pain are common presenting symptoms of SCAD, although mechanisms underlying dissection-related pain remains incompletely understood [4][5][6][7][8]. The relationship between previous migraine and painful SCAD was investigated in only two studies with opposite findings and therefore it is still a matter of controversy [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Primary headaches and painful spontaneous cervical artery dissection

et al. 2007

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The relation between primary headaches (PH) and pain related to spontaneous cervical artery dissection (SCAD) is still unclear, as well as the progress of PH after dissection. To investigate this relation, the characteristics of pain related to SCAD and changes in PH patterns after SCAD, we evaluated 54 consecutive patients. Thirty-five (65%) had previous PH. Painful SCAD occurred in 39 (72%). Frontal and parietal localizations were significantly associated with internal carotid artery dissection (p=0.013 and p=0.010, respectively), whereas occipital and nuchal pain, with vertebral artery dissection (p=0.047 and p<0.001, respectively). Previous PH did not influence the presence of pain at SCAD onset. Twenty-six (74%) patients with PH reported improvement in PH pattern after a mean follow-up of 32 months. These results suggest that mechanisms underlying PH do not modulate dissectionrelated pain. Disruption of perivascular afferents may be involved in improvement of PH patterns after SCAD.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

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Primary headaches and painful spontaneous cervical artery dissection

et al. 2007

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“…Esse achado confi rma a alta freqüência desse sintoma, que em outros estudos variou de 55-95% 25 . A cefaléia foi seguida, na maioria dos casos, por um défi cit motor.…”

Section: Figura Paciente Do Ambulatório De Neurologia Vascular Da Epunclassified

Dissecção espontânea das artérias carótidas e vertebrais em uma população multiétnica

Pieri

Spitz

Valiente

et al. 2007

Arq. Neuro-Psiquiatr.

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RESUMO -A dissecção espontânea das artérias carótidas e vertebrais (DEACV) é considerada uma causa rara de acidente vascular cerebral, particularmente em países com população multiétnica. O objetivo desse estudo foi avaliar características clínicas e de neuroimagem dos pacientes com DEACV em uma população multiétnica. Foram estudados 66 pacientes com diagnóstico de DEACV em dois hospitais terciários de São Paulo. Aplicou-se um questionário inicial e os pacientes foram seguidos prospectivamente. Dos pacientes estudados, 82% eram brancos, 53% eram homens e a média de idade foi 41,7 anos. Os fatores de risco cardiovasculares mais freqüentes foram hipertensão arterial e tabagismo. Outros aspectos avaliados foram histó-ria prévia de enxaqueca, tratamento inicial e prognóstico. Concluiu-se que apesar da população estudada ser multiétnica, houve um marcante predomínio de brancos. A análise das características clínicas e de neuroimagem dos pacientes com DEACV possibilita um melhor conhecimento da doença, levando a um diagnóstico precoce e tratamento mais adequado.PALAVRAS-CHAVE: dissecação da artéria vertebral, dissecação da artéria carótida interna, acidente cerebrovascular, grupos étnicos. Spontaneous carotid and vertebral arteries dissection in a multiethnic populationABSTRACT -Spontaneous dissection of the carotid and vertebral arteries (SDCVA) is considered a rare cause of stroke, particularly in countries with multiethnic population. The objective was to evaluate the clinical and neuroimaging features of patients with SDCVA from a multiethnic population. Sixty-six patients diagnosed with SDCVA were studied at two tertiary hospitals at São Paulo. An initial questionnaire was completed and patients were followed prospectively. Among the patients studied, 82% were caucasian, 53% were male and the average age was 41.7 years old. The most frequent cardiovascular risk factors found were systemic hypertension and tobacco use. Other aspects evaluated were history of previous migraine, initial treatment and prognosis. In conclusion, although the population studied was multhiethnic, there was a marked predominance of caucasians. The analysis of clinical and neuroimaging data from patients with SDCVA allows a better understanding of the disease, leading to an earlier diagnosis and more appropriate treatment.KEY WORDS: vertebral artery dissection, carotid artery internal dissection, cerebrovascular disorder, ethnic groups. A dissecção espontânea das artérias carótidas e vertebrais (DEACV) caracteriza-se pela sua ruptura não traumática, entre as camadas arteriais, levando à redução do diâmetro da luz da artéria ou à formação de dilatação aneurismática . Novos estudos são necessários para o esclarecimento de dúvidas que ainda persistem quanto à etiologia, diagnóstico, tratamento e prognóstico dos pacientes com DEACV, especialmente em populações multiétnicas. O objetivo deste estudo foi descrever, a partir de uma série de casos, as características clínicas e os achados de neuroimagem mais freqüentemente observados nos pacientes ...

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“…1 However, when the pattern of headache or neurological symptoms are different from previous attacks, another cause may be involved, including dissection of one or more cervicocephalic arteries. 2,3 This is illustrated in the following patient. …”

mentioning

confidence: 91%

Spontaneous Bilateral Internal Carotid Artery Dissection and Migraine: A Potential Diagnostic Delay

1997

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A 36-year-old man with a history of migraine without aura, presented with recurrent bouts of severe headache, perception of flashing lights in both visual fields, and transient bilateral neurological deficits. In view of his history, migraine with aura was considered. Ancillary investigations showed bilateral extracranial internal carotid artery dissection. This case illustrates that when attacks of severe headache with scotomata and transient bilateral neurological deficits occur in a patient with a history of migraine, the diagnosis of carotid artery dissection should be considered, especially when the pattern of headache is different or when some clinical characteristics have not been experienced previously.Key words: carotid artery, dissection, migraine Abbreviations:ICA internal carotid artery, ICAD internal carotid artery dissection (Headache 1997;37:109-112) Repeated bouts of headache associated with transient visual, motor, and speech disturbances in young or middle-aged patients with migraine may be suggestive of migraine with aura. 1 However, when the pattern of headache or neurological symptoms are different from previous attacks, another cause may be involved, including dissection of one or more cervicocephalic arteries. 2,3 This is illustrated in the following patient. CASE HISTORYA 36-year-old, right-handed man had a history of migraine without aura. Two weeks before admission, he suddenly experienced severe left-sided occipital headache radiating to the retro-orbital region. There was no history of trauma or physical exertion. The headache resolved spontaneously within 2 days. One week later, he suddenly noted flashing lights in both eyes, followed by markedly decreased visual acuity, light-headedness, left periorbital headache, and weakness of the extremities. Weakness persisted for a few minutes on the right side, and for 2 hours on the left side. The headache progressively waned within 24 hours. Five days later, left-sided frontal headache, light-headedness, and bilaterally decreased visual acuity recurred, accompanied by bilateral weakness of the extremities, more pronounced on the left. The neurological signs disappeared within 30 hours.Two days later, bifrontal headache and perception of flashing lights in both visual fields recurred, accompanied by left hemiparesis and dysarthria. As the left-sided weakness had not disappeared within 48 hours, he was referred to the emergency department. Physical examination showed a blood pressure of 200/120 mm Hg, dysarthria, left hemiparesis, left sensory and visual neglect, generalized hyperreflexia, and bilateral extensor plantar responses. Ophthalmological examination was normal.Blood chemistry and hematology were normal. There was no evidence of coagulopathy, inflammatory, or autoimmune disease. Electro-cardiogram and chest x-ray were normal. Brain CT showed a right parietal infarction.Color duplex ultrasound showed no stenosis at the level of the carotid bifurcations, but was suggestive of a high-grade stenosis at the most distal part of the righ...

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Head Pain in Non-Traumatic Carotid Artery Dissection: A Series of 65 Patients

Cited by 190 publications

References 10 publications

Primary headaches and painful spontaneous cervical artery dissection

Primary headaches and painful spontaneous cervical artery dissection

Dissecção espontânea das artérias carótidas e vertebrais em uma população multiétnica

Spontaneous Bilateral Internal Carotid Artery Dissection and Migraine: A Potential Diagnostic Delay

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