This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gallai, V. Articles by Parnetti, L. Search for Related Content PubMed PubMed Citation Articles by Gallai, V. Articles by Parnetti, L. Related Collections Acute Cerebral Infarction Carotid and Vertebral A. Dissection Risk Factors for Stroke Other Vascular biology

(Stroke. 2001;32:714.)
© 2001 American Heart Association, Inc.

Original Contributions

Mild Hyperhomocyst(e)inemia

A Possible Risk Factor for Cervical Artery Dissection

Virgilio Gallai, MD; Valeria Caso, MD; Maurizio Paciaroni, MD; Gabriela Cardaioli, MD; Erland Arning, PhD; Teodoro Bottiglieri, MD, PhD Lucilla Parnetti, MD, PhD

From the Neuroscience Department, University of Perugia, Perugia, Italy (V.G, V.C., M.P., G.C., L.P.), and Institute of Metabolic Disease, Baylor University Medical Center, Dallas, Tex (E.A., T.B.).

Correspondence to Prof Virgilio Gallai, Department of Neuroscience, University of Perugia, Via Enrico dal Pozzo, 06126 Perugia, Italy. E-mail neurol{at}unipg.it

Background and Purpose—The pathogenesis of cervical artery dissection (CAD) remains unknown in most cases. Hyperhomocyst(e)inemia [hyperH(e)], an independent risk factor for cerebrovascular disease, induces damage in endothelial cells in animal cell culture. Consecutive patients with CAD and age-matched control subjects have been studied by serum levels of homocyst(e)ine and the genotype of 5,10-methylenetetrahydrofolate reductase (MTHFR).

Methods—Twenty-six patients with CAD, admitted to our Stroke Unit (15 men and 11 women; 16 vertebral arteries, 10 internal carotid arteries), were compared with age-matched control subjects. All patients underwent duplex ultrasound, MR angiography, and/or conventional angiography.

Results—Mean plasma homocyst(e)ine level was 17.88 µmol/L (range 5.95 to 40.0 µmol/L) for patients with CAD and 6.0±0.99 µmol/L for controls (P<0.001). The genetic analysis for the thermolabile form of MTHFR in CAD patients showed heterozygosity in 54% and homozygosity in 27%; comparable figures for controls were 40% (P=0.4) and 10% (P=0.1), respectively.

Conclusions—Mild hyperH(e) might represent a risk factor for cervical artery dissection. The MTHFR mutation is not significantly associated with CAD. An interaction between different genetic and environmental factors probably takes place in the cascade of pathogenetic events leading to arterial wall damage.

Key Words: amine oxidoreductases • dissection • homocyst(e)ine • stroke • ultrasonography

This article has been cited by other articles:

				V Caso and M Paciaroni MTHFR 677 TT genotype and hyperhomocysteinaemia: an underestimated risk TANDEM for patients with stroke J. Neurol. Neurosurg. Psychiatry, October 1, 2006; 77(10): 1103 - 1103. [Full Text] [PDF]

				M Kloss, T Wiest, S Hyrenbach, I Werner, M-L Arnold, C Lichy, and C Grond-Ginsbach MTHFR 677TT genotype increases the risk for cervical artery dissections. J. Neurol. Neurosurg. Psychiatry, August 1, 2006; 77(8): 951 - 952. [Abstract] [Full Text] [PDF]

				P. Bosco, G. Anello, R. Ferri, R.-M. Gueant-Rodriguez, J.-L. Gueant, S. Cronin, and P. Kelly Heterogeneity of Association Between MTHFR and Stroke Among European Regions: Additional Population Studies Are Needed in Italy Stroke, March 1, 2006; 37(3): 761 - 762. [Full Text] [PDF]

				I. C. Duncan and J. M. Terblanche Spontaneous Isolated Posterior Communicating Artery Dissection in a Young Adult with Hyperhomocysteinemia AJNR Am. J. Neuroradiol., September 1, 2005; 26(8): 2030 - 2032. [Abstract] [Full Text] [PDF]

				J.-M. de Bray and R. W. Baumgartner History of Spontaneous Dissection of the Cervical Carotid Artery Arch Neurol, July 1, 2005; 62(7): 1168 - 1170. [Full Text] [PDF]

				S. Cronin, K. L. Furie, and P. J. Kelly Dose-Related Association of MTHFR 677T Allele With Risk of Ischemic Stroke: Evidence From a Cumulative Meta-Analysis Stroke, July 1, 2005; 36(7): 1581 - 1587. [Abstract] [Full Text] [PDF]

				S. M. Rubinstein, S. M. Peerdeman, M. W. van Tulder, I. Riphagen, and S. Haldeman A Systematic Review of the Risk Factors for Cervical Artery Dissection Stroke, July 1, 2005; 36(7): 1575 - 1580. [Abstract] [Full Text] [PDF]

				B Thanvi, S K Munshi, S L Dawson, and T G Robinson Carotid and vertebral artery dissection syndromes Postgrad. Med. J., June 1, 2005; 81(956): 383 - 388. [Abstract] [Full Text] [PDF]

				V. Caso and V. Gallai Why Should Mild Hyperhomocysteinemia Be Responsible for CAD? Stroke, November 1, 2003; 34 (11): e209 - e209. [Full Text] [PDF]

				P.J. Kelly, K.L. Furie, J.P. Kistler, M. Barron, E.H. Picard, R. Mandell, and V.E. Shih Stroke in young patients with hyperhomocysteinemia due to cystathionine beta-synthase deficiency Neurology, January 28, 2003; 60(2): 275 - 279. [Abstract] [Full Text] [PDF]

				T. Brandt and C. Grond-Ginsbach Spontaneous Cervical Artery Dissection: From Risk Factors Toward Pathogenesis Stroke, March 1, 2002; 33(3): 657 - 658. [Full Text] [PDF]

				A. Pezzini, E. Del Zotto, S. Archetti, R. Negrini, P. Bani, A. Albertini, M. Grassi, D. Assanelli, R. Gasparotti, L. A. Vignolo, et al. Plasma Homocysteine Concentration, C677T MTHFR Genotype, and 844ins68bp CBS Genotype in Young Adults With Spontaneous Cervical Artery Dissection and Atherothrombotic Stroke Stroke, March 1, 2002; 33(3): 664 - 669. [Abstract] [Full Text] [PDF]

				P. B. Gorelick Stroke Prevention Therapy Beyond Antithrombotics: Unifying Mechanisms in Ischemic Stroke Pathogenesis and Implications for Therapy: An Invited Review Stroke, March 1, 2002; 33(3): 862 - 875. [Abstract] [Full Text] [PDF]