Traumatic bilateral vertebral artery dissection

Galtés, Ignasi; Borondo, Juan Carlos; Cos, Mònica; Subirana, M; Martín, Carles; Castellà, J; Medallo, Jordi

doi:10.1016/j.forsciint.2011.07.005

Cited by 18 publications

(12 citation statements)

References 25 publications

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“…Major and minor cervical trauma [13][14][15][16][17] Arterial hypertension [18][19][20] Young age 12 Current use of oral contraceptives 21 Migraine [22][23][24] Fibromuscular dysplasia 11,[25][26][27][28][29][30][31][32] Ultrastructural connective tissue abnormalities 33 Vascular subtype of Ehlers-Danlos syndrome 34 Marfan syndrome 18,35 Turner syndrome 19,36 Williams syndrome 37 Familial cases 18,38 Hereditary hemochromatosis 39 Osteogenesis imperfecta type I 40 α1-Antitrypsin deficiency 41,42 677T genotype MTHFR [43][44][45] Hyperhomocysteinemia 46 Cystic medial necrosis of intracranial vessels 47 Styloid process length 48 ICAM-1 E4690 K gene polymorphism 49 Autosomal-dominant polycystic kidney disease 50 Infections [51][52][53][54] Moyamoya disease …”

Section: Table 1 Factors Associated With CDmentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

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3155Purpose-Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults.The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. Results-Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.

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Section: Table 1 Factors Associated With CDmentioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

179

View full text Add to dashboard Cite

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“…In some cases, no thrombus was detected in the vertebrobasilar system. [19][20][21] Norris et al 1 demonstrated that in CVAD patients, cerebral infarction occurred due to emboli originating from thrombus at sites of arterial dissection. Of the 74 patients, they surveyed, two autopsied patients were reported.…”

Section: Discussionmentioning

confidence: 99%

Traumatic cervical vertebral artery dissection: A case with cerebral infarct due to newly formed thrombus in the cerebral arteries

Takeda¹,

Fujimoto²,

Onda³

2020

Neuropathology

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We report a 50-year-old man who developed fatal brainstem infarction five days after traumatic cervical vertebral artery dissection (CVAD). Autopsy revealed multiple fresh infarcts in the territory of the vertebrobasilar system. No thrombus was found in the infarct lesions. The cervical vertebral artery (CVA) showed severe atherosclerotic stenosis extending to the proximal half of the left side, similar stenosis at the origin on the right side, fresh thrombotic occlusion extending to the proximal half of the right side, and multiple dissections in the distal foraminal segments on both sides. In the distal half of the basilar artery (BA) and the origin of the right posterior cerebral artery (PCA), the lumen was extensively filled with fresh thrombus. Although an intricate mixture of white and red thrombi filled the lumen at the origin of the right PCA, the white thrombus gradually appeared at the periphery whereas the red thrombus occupied the central and more proximal part of the BA. We confirm that cerebral infarction associated with CVAD is due not only to emboli originating from the dislodged thrombus at sites of arterial dissection, as reported previously, but also to newly formed thrombus in the cerebral arteries caused by impaired blood flow, as was seen in the present case.

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“…It is likely that our case went through same process after traumatic VA dissection, causing progressive thromboembolic event. VA dissection usually arises from an intimal tear, which allows blood under arterial pressure to enter between the layers of the wall of the artery, forming an intramural hematoma, the so-called false lumen 7) . The interludes are likely due to the slow progression of thrombosis or the gradual swelling of the vessel 18 , 24) .…”

Section: Discussionmentioning

confidence: 99%

“…The mechanism responsible for VA injury has been suggested to be stretching, tearing of the intima and media, or compression of the vessels 18 , 20) . Motor vehicle accidents are the leading cause of VA injury due to the major rotational component 4 , 7) . Rotational forces applied to the mobile portions of the cervicocephalic arteries are responsible for intimal tears 20) .…”

Section: Discussionmentioning

confidence: 99%

“…However, bilateral VA injury was previously considered to be rare because of inadequate imaging modalities 4 , 6 , 14) , or the clinical silence of this condition 2 , 16 , 24) . The prompt diagnosis of VA injury requires a high index of suspicion, because the majority of patients exhibit no neurological symptom 4 , 7 , 13 , 20 , 24) . Although the majority of VA injuries are asymptomatic, these injuries can potentially result in devastating outcomes that include cerebral, brain stem, and spinal cord ischemia 2 , 4 , 6 , 10 , 11 , 12 , 13 , 15 , 17) .…”

Section: Introductionmentioning

confidence: 99%

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Delayed Brain Infarction due to Bilateral Vertebral Artery Occlusion Which Occurred 5 Days after Cervical Trauma

Jang

Kim

Lee

et al. 2014

J Korean Neurosurg Soc

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Vertebral artery (VA) injuries usually accompany cervical trauma. Although these injuries are commonly asymptomatic, some result in vertebrobasilar infarction. The symptoms of VA occlusion have been reported to usually manifest within 24 hours after trauma. The symptoms of bilateral VA occlusions seem to be more severe and seem to occur with shorter latencies than those of unilateral occlusions. A 48-year-old man had a C3-4 fracture-dislocation with spinal cord compression that resulted from a traffic accident. After surgery, his initial quadriparesis gradually improved. However, he complained of sudden headache and dizziness on the 5th postoperative day. His motor weakness was abruptly aggravated. Radiologic evaluation revealed an infarction in the occipital lobe and cerebellum. Cerebral angiography revealed complete bilateral VA occlusion. We administered anticoagulation therapy. After 6 months, his weakness had only partially improved. This case demonstrates that delayed infarction due to bilateral VA occlusion can occur at latencies as long as 5 days. Thus, we recommend that patients with cervical traumas that may be accompanied by bilateral VA occlusion should be closely observed for longer than 5 days.

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Traumatic bilateral vertebral artery dissection

Cited by 18 publications

References 25 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Traumatic cervical vertebral artery dissection: A case with cerebral infarct due to newly formed thrombus in the cerebral arteries

Delayed Brain Infarction due to Bilateral Vertebral Artery Occlusion Which Occurred 5 Days after Cervical Trauma

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