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Extracranial vertebral artery dissection: nine cases
1Department of Neurology, Hôpital B, CHU, Lille, France.
Insights
Extracranial vertebral artery dissection, often linked to minor trauma or underlying conditions, typically resolves well with treatment. Recurrence can occur if antiplatelet therapy is stopped.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Extracranial vertebral artery dissection (EVAD) is a significant cause of stroke in younger adults.
- Understanding the risk factors and outcomes of EVAD is crucial for effective patient management.
Observation:
- This study describes nine patients diagnosed with extracranial vertebral artery dissection.
- Patient demographics included a mean age of 39.1 years, with a male predominance (6 men, 3 women).
- Dissections were spontaneous in four cases and associated with trivial trauma in five.
Findings:
- Underlying conditions such as fibromuscular dysplasia, migraine, and elastorrhexis were noted in some patients.
- Treatment modalities included anticoagulation with heparin and antiplatelet therapy with acetylsalicylic acid or ticlopidine.
- Eight out of nine patients achieved a good recovery, though two experienced recurrence upon cessation of antiplatelet medication.
Implications:
- The findings suggest that EVAD, despite potential underlying causes, often has a favorable prognosis with appropriate treatment.
- The study highlights the importance of continued antiplatelet therapy to prevent recurrence.
- Further research into the pathogenesis and differentiation between spontaneous and trauma-related dissections is warranted.
Abstract:
Nine patients (six men, three women) with extracranial vertebral artery dissection are described. Their mean age was 39.1 years (range 17-66). In four cases dissection was "spontaneous"; in the other five cases there was a history of trivial trauma. Three patients had fibromuscular dysplasia, two were migraineurs, one had elastorrhexis. Treatment varied. Six received heparin, three acetylsalicylic acid or ticlopidine. Eight had good recovery. Two patients experienced recurrence when stopping acetylsalicylic acid. The pathogenesis of dissections and the distinction between spontaneous dissections and those associated with minor trauma are discussed.