This Article Full Text Full Text (PDF) Correction (v38,p208) All Versions of this Article: 37/10/2499    most recent 01.STR.0000240493.88473.39v1 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 Arnold, M. Articles by Baumgartner, R. W. Search for Related Content PubMed PubMed Citation Articles by Arnold, M. Articles by Baumgartner, R. W. Related Collections CT and MRI Cardiovascular Nursing Carotid and Vertebral A. Dissection

(Stroke. 2006;37:2499.)
© 2006 American Heart Association, Inc.

Original Contributions

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 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.

Correspondence to Ralf W. Baumgartner, MD, Department of Neurology, University Hospital, Frauenklinikstrasse 26, 8091 Zürich, Switzerland. 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

This article has been cited by other articles:

				U. Umasankar, T. J. Carroll, A. Famuboni, M. D. Patel, and I. D. Starke Vertebral artery dissection: not a rare cause of stroke in the young Age Ageing, May 1, 2008; 37(3): 345 - 346. [Abstract] [Full Text] [PDF]

				G. Tsivgoulis, V. K. Sharma, S. L. Hoover, A. Y. Lao, A. A. Ardelt, M. D. Malkoff, and A. V. Alexandrov Applications and Advantages of Power Motion-Mode Doppler in Acute Posterior Circulation Cerebral Ischemia Stroke, April 1, 2008; 39(4): 1197 - 1204. [Abstract] [Full Text] [PDF]

				J.P.P. Peluso, W.J. van Rooij, M. Sluzewski, G.N. Beute, and C.B. Majoie Endovascular Treatment of Symptomatic Intradural Vertebral Dissecting Aneurysms AJNR Am. J. Neuroradiol., January 1, 2008; 29(1): 102 - 106. [Abstract] [Full Text] [PDF]

				A. Metso, T. Metso, O. Salonen, and T. Tatlisumak Response to Letter by Arnold et al Stroke, November 1, 2007; 38(11): e141 - e141. [Full Text] [PDF]