[Dissections of the carotid and vertebrobasilar arteries]

Ischaemic strokes and TIA are increasingly being found to be due to arterial cervical dissection, particularly in young adults. Physicians have better knowledge of this disease, and diagnostic neuroimagery has improved. Sometimes traumatic, arterial dissection can also be truly spontaneous or coincides with ordinary neck movement. Dissection consists in an intramural hematoma, and affects most commonly the carotid artery. In 25% of cases, two or more cervical arteries appear to be affected simultaneously, suggesting fibromuscular dysplasia. Pathophysiological considerations remain unclear and several hypotheses are considered. Clinical manifestations are evocative and cervical warning signs such as pain, headache or Horner's syndrom provide an opportunity to recognize the patients few hours or days before cerebral or ocular ischemia occurs. Conventional angiography remains the gold standard in the diagnosis of arterial dissections but ultrasonography and magnetic resonance techniques are more and more often informative. Although no therapeutical trial is available, anticoagulant therapy has been recommended, except in intracranial dissection. Recurrent dissections are very rare and long term functional prognosis seems to be favourable.