Published Online
on September 7, 2006

A more recent version of this article appeared on October 1, 2006

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Submitted on February 4, 2006
Revised on April 19, 2006
Accepted on May 30, 2006

Vertebral Artery Dissection. Presenting Findings and Predictors of Outcome

Marcel Arnold MD; Marie Germaine Bousser; Gregor Fahrni MS; Urs Fischer MD; Dimitrios Georgiadis MD; Joubin Gandjour MD; David Benninger MD; Matthias Sturzenegger MD; Heinrich P. Mattle MD; and Ralf W. Baumgartner MD^*

From the Department of Neurology (M.A., M.G.B.), Assistance Publique, Hôpitaux de Paris, Lariboisière, Paris, France; the Department of Neurology (M.A., U.F., M.S., H.P.M.), University Hospital Bern, Bern, Switzerland; and the Department of Neurology (G.F., D.G., J.G., D.B., R.W.B.), University Hospital Zurich, Zurich, Switzerland.

^* To whom correspondence should be addressed. E-mail: ralf.baumgartner{at}usz.ch.

Background and Purpose--Few data exist about clinical, radiologic findings, clinical outcome, and its predictors in patients with spontaneous vertebral artery dissection (sVAD).

Methods--Clinical characteristics, imaging findings, 3-month outcomes, and its predictors were investigated in consecutive patients with sVAD.

Results--One hundred sixty-nine patients with 195 sVAD were identified. Brain ischemia occurred in 131 patients (77%; ischemic stroke, n=114, 67%; transient ischemic attack, n=17, 10%). Three patients with ischemic stroke showed also signs of subarachnoid hemorrhage (SAH); 3 (2%) had SAH without ischemia. The 134 patients with brain ischemia or SAH had head and/or neck pain in 118 (88%) and pulsatile tinnitus in seven (5%) patients. The remaining 35 patients (21%) had isolated head and/or neck pain in 21 (12%) cases, asymptomatic sVAD in 13 (8%), and cervical radiculopathy in one case (1%). Location of sVAD was more often in the pars transversaria (V2; 35%) or atlas loop (V3; 34%) than in the prevertebral (V1; 20%) or intracranial (V4; 11%) segment (P=0.0001). Outcome was favorable (modified Rankin scale score 0 or 1) in 88 (82%) of 107 ischemic stroke patients with follow up. Two (2%) patients died. Low baseline National Institutes of Health Stroke Scale score (P<0.0001) and younger age (P=0.007) were independent predictors of favorable outcome.

Conclusions--sVAD is predominantly located in the pars transversaria (V2) or the atlas loop (V3). Most patients show posterior circulation ischemia. Favorable outcome is observed in most ischemic strokes and independently predicted by low National Institutes of Health Stroke Scale score and younger age.

Key words: dissection • MRI • outcome • stroke

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