Cervical Arterial Dissection:Is It Always Traumatic?
Background Cervical arterial dissections are one of the leading causes of stroke in the young. Role of trauma in the pathophysiology of dissection is underestimated, especially since neurological presentation may be delayed and traumatic cases are often judged as “spontaneous”. Role of genetic predisposition is unclear. Methods The Canadian Stroke Consortium is presently conducting a prospective national study of arterial cervical dissections. We are collecting data on the mechanism of dissection (spontaneous or traumatic) and therapeutic strategies. All cases have angiographic confirmation. Results In 94 patients so far (m/f:52/42;mean age 43.2,range 16–87) there were 62 vertebral artery (VA) and 32 carotid artery (CA) dissections. “Violent” trauma (e.g.neck manipulation) caused 20 dissections in VA and 6 in CA group. Trivial trauma (e.g.various head turns, heavy lifting, etc.) included 32 cases in VA and 12 in CA group. The median time between trauma and clinical presentation was 24 hours (minutes-49 days in VA and minutes-25 days in CA group). Fibromuscular dysplasia or Marfan’s syndrome were observed in 14 patients. There were 6 (10%) cases of recurrent episodes in VA group vs. 5(16%) in carotid [12% overall] despite pharmaceutical intervention before discharge. The severity varied from TIAs to devastating strokes. Conclusions The majority of cervical arterial dissections are traumatic. Careful history taking is essential in deciding the mechanism of dissection. Neurological symptoms may occur within months after trauma due to the permanent vascular damage consequent to dissection. Detailed assessment of underlying vascular structural fragility is needed to define patients at risk.