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Intracranial dissections
1Beth Israel Deaconess Medical Center, Department of Neurology, Division of Cerebrovascular Disease, Boston, Mass., USA.
Insights
Intracranial artery dissections are rare, with limited data compared to extracranial dissections. Understanding the dissection location within the arterial wall is crucial for determining treatment and prognosis for ischemic or aneurysmal complications.
Area of Science:
- Neurology
- Vascular Surgery
- Pathology
Background:
- Intracranial artery dissections are infrequently reported, unlike more studied extracranial dissections.
- The arterial wall's specific dissection layer significantly impacts clinical presentation and outcomes.
- Limited data exists on the pathology and clinical course of intracranial dissections.
Purpose of the Study:
- To review the underlying pathology and etiology of intracranial dissections.
- To discuss the clinical manifestations of both ischemic and aneurysmal intracranial dissections.
- To provide a comprehensive overview of intracranial dissections.
Main Methods:
- Literature review of intracranial dissections.
- Analysis of pathology and etiology.
- Discussion of clinical findings, treatment, and prognosis.
Main Results:
- Dissections between the intima and media lead to vascular occlusion and ischemia.
- Dissections between the media and adventitia can cause aneurysmal dilatation and rupture.
- Pathology dictates whether the dissection presents as ischemic or aneurysmal.
Conclusions:
- Accurate identification of dissection plane is key for managing intracranial dissections.
- Intracranial dissections can manifest with diverse clinical presentations, including ischemia and aneurysm formation.
- Further research is needed to fully elucidate the characteristics of intracranial dissections.
Abstract:
Intracranial dissections have only been reported in small case series. More is known about the pathology, clinical findings, treatment and prognosis related to extracranial dissections. Knowing where within the arterial wall the dissection occurs is important in determining the appropriate treatment and prognosis. If the internal aspect of the artery is dissected, between the intima and media, vascular occlusion with resulting ischemia results. When the dissection plane is between the media and adventitia, bulging of the artery, with resultant aneurysmal dilatation, and vascular rupture can occur. In this chapter on intracranial dissections we will first review the pathology and etiology underlying intracranial dissections, then discuss the clinical aspects of both ischemic and aneurysmal intracranial dissections.
