vertebral artery dissection
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Introduction
Clinical manifestations
- severe unilateral headache with neck stiffness & nausea.
- constant intense umilateral occipital & neck pain & nausea
- balance impairment & visual loss common[2]
- Wallenberg syndrome via lateral medullary infarction[2]
- patients >= 60 years of age less likely to present with cervical pain (RR=0.47), headache (RR=0.58), or history of mechanical triggers (RR=0.53)[5]
- does not cause hemispheric stroke[7]
Radiology
- head CT may be normal
Complications
- distal embolization
- embolic stroke risk is low[4]
- thrombus formation at the site of dissection
- arterial thromboembolism[2]
- risk of recurrent stroke is 2.5% at 1 year[6]
Management
- see carotid artery dissection
- aspirin 81-325 mg PO QD for platelet inhibition better than heparin followed by warfarin[2]
- aspirin is not non-inferior to vitamin K antagonist (warfarin)[8]
- no evidence that antiplatelet agents or anticoagulants of benefit in reducing risk of recurrent stroke[6]
More general terms
Additional terms
References
- ↑ Kidwell CS and Burgess RE Dissection Syndromes eMedicine: Neurology http://en.wikipedia.org/wiki/Carotid_artery_dissection
- ↑ 2.0 2.1 2.2 2.3 2.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021
Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025 - ↑ Caplan LR. Dissections of brain-supplying arteries. Nat Clin Pract Neurol. 2008 Jan;4(1):34-42 PMID: https://pubmed.ncbi.nlm.nih.gov/18199995
- ↑ 4.0 4.1 The CADISS trial investigators. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): A randomised trial. Lancet Neurol 2015 Feb 12 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/25684164 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2815%2970018-9/abstract
- ↑ 5.0 5.1 Traenka C, Dougoud D, Simonetti BG et al. Cervical artery dissection in patients >= 60 years: Often painless, few mechanical triggers. Neurology 2017 Apr 4; 88:1313 <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/28258079 <Internet> http://www.neurology.org/content/88/14/1313
- ↑ 6.0 6.1 6.2 Markus HS, Levi C, King A et al Antiplatelet Therapy vs Anticoagulation Therapy in Cervical Artery Dissection. The Cervical Artery Dissection in Stroke Study (CADISS) Randomized Clinical Trial Final Results. JAMA Neurol. Published online February 25, 2019 PMID: https://pubmed.ncbi.nlm.nih.gov/3080162 https://jamanetwork.com/journals/jamaneurology/fullarticle/2725385
- ↑ 7.0 7.1 7.2 NEJM Knowledge+ Question of the Week Feb 18, 2020 https://knowledgeplus.nejm.org/question-of-week/1356/
Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001 Mar 22; 344:898. https://www.nejm.org/doi/full/10.1056/NEJM200103223441206 - ↑ 8.0 8.1 Engelter ST et al. Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): An open-label, randomised, non-inferiority trial. Lancet Neurol 2021 Mar 22; [e-pub]. PMID: https://pubmed.ncbi.nlm.nih.gov/33765420 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(21)00044-2/fulltext