[Pain and ischemic symptoms in craniocervical artery dissection]

Arterial dissections of craniocervical arteries are being increasingly identified due to the growing awareness of the clinical picture and advances in imaging technologies. During a one-year period, we observed 20 patients with craniocervical artery dissection at cerebrovascular laboratory. Clinical picture, localization of the dissection and follow up studies were analyzed. Twenty study patients were divided into four groups: in group 1, all 4 patients with common carotid dissection with or without aortic dissection presented with pain; in group 2 with internal carotid dissection, pain was present in 5 out of 11 patients, ischemic symptoms in all 11 patients, and Horner syndrome or lower cranial nerve palsies in 3 of 11 patients; in group 3, all 4 patients with dissecting plaque were free from pain but had ischemic symptoms; and in group 4 there was only one patient with isolated vertebral artery dissection who had no pain but presented with stroke. Pain was the most prominent symptom in patients with lower craniocervical artery dissection. Ultrasound enabled follow up of the dissection.