Recent Infection And Risk of Spontaneous Cervical Artery Dissection: A Case-Control Study
Background and Purpose: Spontaneous cervical artery dissection (SCAD) is a major cause of stroke in young adults, for which an underlying arteriopathy related to a generalized extracellular matrix defect could often be a predisposing condition. As triggering factors such as minor trauma/strenuous exercise or infection may be implicated in the occurrence of SCAD, we conducted a case-control study to assess the relationship between recent infection and risk of SCAD. Methods: Forty-eight patients with SCAD and 52 patients with ischemic stroke from other causes (controls) were recruited prospectively and consecutively from two centers during an 18-month period. Controls were included if they were roughly comparable to cases for sex and age. To analyze the history of recent infection (within one month before SCAD or ischemia), a face-to-face interview, with a structured questionnaire focused on symptoms typical of infection, was performed as soon as possible after admission. Results: Patients and controls were comparable for age (44.6 (7.5) vs 45.2 (9.1), P=0.72) and sex distribution (46% of women vs 43%, P=0.81). Recent infection was found in 31.3% (15/48) of patients with SCAD and 13.5% (7/52) of controls, yielding a crude odds ratio of 2.92 (95% CI, 1.07 to 8.74; P=0.032). In a logistic model adjusted for age, sex, center, educational level and migraine, the odds ratio for recent infection in cases was 3.05 (95% CI, 1.06 to 8.74; P=0.038). Conclusion: This prospective case-control study showed a significant association between recent infection and SCAD, consistent with the triggering role of an infectious process in the occurrence of SCAD.