II. Definitions
- Cervical Artery Dissection (Cervicocerebral Arterial Dissection)
- Extracranial Arterial Dissection includes carotid dissection and Vertebral Dissection
III. Epidemiology
- Cervical Artery Dissection (Carotid Artery and Vertebral Artery) are uncommon overall
- Overall: <2% of ischemic Cerebrovascular Accidents
- Young Patients: 10-25% of ischemic Cerebrovascular Accidents
IV. Pathophysiology
- Vessel intima tear or vasa vasorum rupture
- Vessel wall media develops localized bleeding
- Blood within vessel wall separates layers resulting in a false lumen
- Aneurysm may form if vessel wall hematoma expands toward adventitia (sub-adventitial dissection)
- Vessel lumen may be narrowed if vessel wall expands towards intima
VI. Causes
-
Genetic Predisposition, Typically Connective Tissue Disorder (spontaneous dissection)
- Ehlers-Danlos Syndrome Type IV
- Marfan's Syndrome
- Autosomal Dominant Polycystic Kidney Disease
- Osteogenesis Imperfecta Type 1
-
Hypertension or rotation of the neck (esp. if sudden)
- Yoga
- Painting ceiling
- Coughing, Sneezing or Vomiting
- Procedural Sedation
- Trauma
- Respiratory infection
- Autumn peak in dissection Incidence also may suggest infectious contributing factors
- Other possible risk factors
- Coronary Artery Disease Risk Factors
- Migraine Headache with aura
VII. Findings
- See Carotid Artery Dissection
- See Vertebral Artery Dissection
- Findings are specific to distribution of dissection
VIII. Differential Diagnosis
IX. Imaging
- CT Angiogram Head and Neck
- Optimal in Vertebral Artery Dissection
- Double lumen sign (false and true lumen)
- Flame-like taper of vessel lumen
- MRI/MRA Head and Neck (T1 axial cervical with fat saturation)
- Overall preferred dissection imaging, esp. in Carotid Artery Dissection
- Able to identify intramural hematoma
X. Complications
- Cerebrovascular Infarction (up to 70% of cases)
- Typically occurs in the first 2 weeks of Cervical Artery Dissection
- Functional independence at 3 months in 75% of Cerebrovascular Accident cases
-
Cerebral Vessel Stenosis (e.g. Carotid Artery Stenosis)
- Initially may be symptomatic
- Typically resolves in first 6 months
- Not associated with significant increased Cerebrovascular Accident risk after initial dissection
- Pseudoaneurysm
- Typically persists despite vessel otherwise healing
- Pseudoaneurysm risk of future rupture 1% (esp. intracranial vessels lacking external elastic lamina)
- Recurrent Cervical Artery Dissection
- Occurs in up to 7% of patients within 7 years
XI. Management
- Consult Neurology and Neurosurgery
-
Cerebrovascular Accident
- Systemic or directed Thrombolysis may be recommended by stroke neurology
- Patients may be candidates for intervention (Angioplasty, stenting)
- Antiplatelet Agents or Anticoagulation
- Management is controversial
- Aspirin may be as effective as Anticoagulation in Cervical Artery Dissection
XII. References
- Marcolini and Swaminathan in Herbert (2021) EM:Rap 21(3): 9-11
- Blum (2015) Arch Neurosci 2(4) +PMID:26478890 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Finding (T033) |
| SnomedCT | 230728003 |
| English | Cervicocerebral art dissectn, Cervicocerebral arterial dissection, Cervicocerebral arterial dissection (disorder), Dissection of cervicocerebral artery |
| Spanish | disección arterial cervicocerebral (trastorno), disección arterial cervicocerebral, disección de arteria cervicocerebral |
Ontology: Cerebrovascular aneurysms and dissections (C0949012)
| Concepts | Disease or Syndrome (T047) |
| Italian | Aneurismi e dissezioni cerebrovascolari |
| Japanese | 脳血管瘤および解離, ﾉｳｹｯｶﾝﾘｭｳｵﾖﾋﾞｶｲﾘ |
| Czech | Aneurysmata a disekce mozkových cév |
| Hungarian | Cerebrovascularis aneurysmák és dissectiók |
| English | Cerebrovascular aneurysms and dissections |
| Portuguese | Aneurismas e dissecções cerebrovasculares |
| Spanish | Aneurismas y disecciones cerebrovasculares |
| Dutch | cerebrovasculaire aneurysmata en -dissecans |
| French | Anévrysmes et dissections cérébro-vasculaires |
| German | Zerebrovaskulaere Aneurysmen und Dissektionen |
Ontology: Dissecting aneurysm of precerebral artery (C2919595)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 444935005 |
| English | Dissecting aneurysm of precerebral artery (disorder), Dissecting aneurysm of precerebral artery, Aneurysm and dissection of precerebral artery |
| Spanish | aneurisma disecante de arteria precerebral, aneurisma disecante de arteria precerebral (trastorno) |
