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Cervicocranial arterial dissection.

Qaisar Shah1, Steven R Messé

  • 1Steven R. Messé, MD Hospital of the University of Pennsylvania, Department of Neurology, 3400 Spruce Street, 3 West Gates Building, Philadelphia, PA 19104, USA. messe@mail.med.upenn.edu.

Current Treatment Options in Neurology
|February 10, 2007
PubMed
Summary
This summary is machine-generated.

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Cervicocranial arterial dissection (CCAD) involves tears in neck arteries, potentially causing stroke. Treatment is typically medical, with anticoagulation for early extradural cases and antiplatelets for late ones, avoiding these if subarachnoid hemorrhage is present.

Area of Science:

  • Neurology
  • Vascular Surgery
  • Ophthalmology

Background:

  • Cervicocranial arterial dissection (CCAD) is a tear in the carotid or vertebral arteries.
  • It can lead to embolism, stenosis, or occlusion, causing neurological or ocular symptoms.
  • Common serious complication is ischemic stroke.

Purpose of the Study:

  • To review the presentation, complications, and management of cervicocranial arterial dissection.
  • To highlight the empiric and regionally variable treatment approaches due to lack of randomized trials.

Main Methods:

  • Literature review of cervicocranial arterial dissection.
  • Analysis of clinical presentations, diagnostic considerations, and treatment strategies.
  • Discussion of neuro-ophthalmologic manifestations and stroke risk.

Related Experiment Videos

Main Results:

  • CCAD presents with symptoms like Horner syndrome, headache, or amaurosis fugax; rare presentations include cranial nerve palsies and ischemic optic neuropathy.
  • Medical management is first-line, with anticoagulation (heparin followed by warfarin) for early extradural CCAD and antiplatelets for late, non-ischemic cases.
  • Intradural dissection carries a risk of subarachnoid hemorrhage (SAH), contraindicating anticoagulants/antiplatelets; endovascular intervention is reserved for refractory cases.

Conclusions:

  • CCAD requires prompt consideration in patients with relevant symptoms.
  • Treatment strategies are largely empiric, balancing risks of stroke and hemorrhage.
  • CCAD is not a contraindication for thrombolysis in eligible acute stroke patients.