Spontaneous Dissection of Cervico-Cerebral Arteries

Fisher, Charles K.; Ojemann, Robert G.; Roberson, Glenn H.

doi:10.1017/s0317167100024690

Cited by 254 publications

(109 citation statements)

References 8 publications

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“…As reported previously [6,9,13,27,38], stroke and TIA were the most common presenting features in our study affecting 86 % of patients without a significant difference between CAD and VAD.…”

Section: Discussion S Clinical Findingssupporting

confidence: 85%

“…Chiropractic manipulation of the cervical spine was performed prior to the diagnosis of dissection in 20 (16 %) patients, of whom 5 had CAD, 14 had VAD and one had both CAD and VAD (p < 0.01 for CAD versus VAD). The onset of symptoms occurred immediately after the procedure in (13) or death (%) * p < 0.01 for the comparison of CAD and VAD; "vascular findings" refer to a total of 85 affected carotid arteries and 60 affected vertebral arteries twelve patients and within two to ten days in the remaining eight patients.…”

Section: S Risk Factorsmentioning

confidence: 99%

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Cervical artery dissection?clinical features, risk factors, therapy and outcome in 126 patients

Dziewas

Konrad

Dräger

et al. 2003

Journal of Neurology

340

277

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The highly variable clinical course of cervical artery dissections still poses a major challenge to the treating physician. This study was conducted (1) to describe the differences in clinical and angiographic presentation of patients with carotid and vertebral artery dissections (CAD, VAD), (2) to define the circumstances that are related to bilateral arterial dissections, and (3) to determine factors that predict a poor outcome. Retrospectively and by standardised interview, we studied 126 patients with cervical artery dissections. Preceding traumata, vascular risk factors, presenting local and ischemic symptoms, and patient-outcome were evaluated. Patients with CAD presented more often with a partial Horner's syndrome and had a higher prevalence of fibromuscular dysplasia than patients with VAD. Patients with VAD complained more often of neck pain, more frequently reported a preceding chiropractic manipulation and had a higher incidence of bilateral dissections than patients with CAD. Bilateral VAD was significantly related to a preceding chiropractic manipulation. Multivariate analysis showed that the variables stroke and arterial occlusion were the only independent factors associated with a poor outcome. This study emphasises the potential dangers of chiropractic manipulation of the cervical spine. Probably owing to the systematic use of forceful neck-rotation to both sides, this treatment was significantly associated with bilateral VAD. Patients with dissection-related cervical artery occlusion had a significantly increased risk of suffering a disabling stroke.

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Section: Discussion S Clinical Findingssupporting

confidence: 85%

Section: S Risk Factorsmentioning

confidence: 99%

Cervical artery dissection?clinical features, risk factors, therapy and outcome in 126 patients

Dziewas

Konrad

Dräger

et al. 2003

Journal of Neurology

340

277

View full text Add to dashboard Cite

show abstract

“…Yamaura et al [169] found that such neurological deficits were commonly seen when the aneurysm was located within 10 mm of the midline or more than 13 mm posterior to the clivus. Thrombosis of the VA and its perforators to the medulla is known to play a more important role in the development of lateral medullary infarction than thrombosis of the PICA [21]. When the PICA is a major supplier of blood to the medulla, the PICA should remain patent proximal to the clip.…”

Section: Complications and Their Avoidancementioning

confidence: 99%

State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms

Balik

Yamada

Talari³

et al. 2016

Neurosurg Rev

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Vertebrobasilar (VB) intracranial dissecting aneurysms (IDAs) pose difficult therapeutic issues and are especially among the most difficult to manage surgically. There are, however, some cases where selective aneurysm obliteration by endovascular approach is impossible or is associated with an unacceptable risk of morbidity. This is particularly true when the aneurysm is dissecting, giant, or has a large neck. In such cases, surgical treatment may be the only alternative. Optimal management of these lesions is therefore challenging and treatment decisions have to be made on a case-by-case basis. Ideal treatment should be a complete surgical excision of the lesion; however, this procedure might only be possible after distal and proximal vessel wall occlusion which might not be tolerated by the patient depending on the location of the aneurysm. Therefore, formulation of recommendations concerning the surgical strategy remains still difficult due to inconsistency of surgical outcomes. The literature describing surgical strategy of VB IDAs is varying in quality and content, and many studies deal with only a few patients. In the presented review, the authors summarize the current knowledge on the incidence, pathogenesis, clinical presentation, and diagnostic procedures with special emphasis on surgical treatment of IDAs in posterior circulation.

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“…Catheter-angiography has traditionally been the gold standard for the diagnosis of extracranial carotid and vertebral dissection [59,60]. Dissections are commonly classified as stenotic, occlusive, or aneurysmal, with dissecting aneurysms occurring in 25-50% of patients with internal carotid artery involvement [28,61,62].…”

Section: Diagnosismentioning

confidence: 99%

Non-Atherosclerotic Vascular Disease in the Young

Camilo

Goldstein

2005

J Thromb Thrombolysis

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There are a large variety of non-atherosclerotic causes of ischemic stroke in the young. Arterial dissection, most commonly associated with non-traumatic causes, is among the most common. Both the carotid and vertebrobasilar circulations can be affected. The vasculitidies represent a rare, but potentially treatable series of conditions that can lead to stroke through diverse mechanisms. Moyamoya is a nonatherosclerotic, noninflammatory, nonamyloid vasculopathy characterized by chronic progressive stenosis or occlusion of the distal internal carotid arteries and/or proximal portions of the middle and/or anterior cerebral arteries. Moyamoya can be idiopathic (moyamoya disease) or the result of other conditions. An appreciation of the unusual causes of stroke in the young is important when considering secondary prevention measures.

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Spontaneous Dissection of Cervico-Cerebral Arteries

Cited by 254 publications

References 8 publications

Cervical artery dissection?clinical features, risk factors, therapy and outcome in 126 patients

Cervical artery dissection?clinical features, risk factors, therapy and outcome in 126 patients

State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms

Non-Atherosclerotic Vascular Disease in the Young

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