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Carotid and vertebral artery dissection syndromes
B Thanvi1, S K Munshi, S L Dawson
1Department of Integrated Medicine, Leicester General Hospital, Gwendolen Road, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK. bthanvi@hotmail.com
Postgraduate Medical Journal
|June 7, 2005
Summary
Cervicocerebral arterial dissections (CAD) are a significant cause of stroke in young adults. While the exact causes are unclear, non-invasive imaging aids diagnosis, and medical treatment is common.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Cervicocerebral arterial dissections (CAD) are a leading cause of stroke in individuals under 45, accounting for approximately 20% of all strokes in this demographic.
- Extracranial internal carotid artery dissections represent 70%-80% of CAD cases, while extracranial vertebral dissections constitute about 15%.
Purpose of the Study:
- To review the current understanding of cervicocerebral arterial dissections (CAD), including their causes, diagnostic methods, treatment, and prognosis.
- To highlight the importance of CAD as a cause of stroke in younger populations.
Main Methods:
- Review of existing literature on cervicocerebral arterial dissections.
- Discussion of diagnostic modalities such as Doppler ultrasound, MRI/MRA, and CT angiography.
- Overview of current treatment strategies, primarily medical management with anticoagulants or antiplatelet agents.
Main Results:
- The aetiopathogenesis of CAD remains incompletely understood, with trauma, infections, and arteriopathy being implicated factors.
- Typical symptoms like localized pain, headache, and Horner's syndrome preceding ischemic events are infrequent.
- Non-invasive imaging techniques are crucial for diagnosis.
- Extracranial CAD generally has a better prognosis than intracranial CAD, with a low recurrence rate.
Conclusions:
- Cervicocerebral arterial dissections are a critical consideration in young stroke patients.
- While treatment is predominantly medical, evidence from controlled studies on efficacy is limited.
- The prognosis for extracranial CAD is favorable, with rare recurrences.