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Cerebrovascular dissections--a review part I: Spontaneous dissections
Matthew R Fusco1, Mark R Harrigan
1Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Neurosurgery
|December 15, 2010
Summary
Spontaneous cerebrovascular dissections, a cause of ischemic strokes, particularly in young adults, often result from minor trauma. Treatment primarily involves antithrombotic medication, though evidence guiding therapy is limited.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Spontaneous cerebrovascular dissections involve arterial wall injuries in the neck, leading to ischemic strokes.
- These dissections are the primary cause of stroke in individuals under 45, representing a significant portion of strokes in this demographic.
- Minor trauma is a reported factor in nearly 25% of dissection cases.
Purpose of the Study:
- To summarize the current understanding of spontaneous cerebrovascular dissections, including their causes, diagnostic methods, and treatment approaches.
- To highlight the diagnostic challenges and the lack of definitive evidence for current therapeutic strategies.
Main Methods:
- Review of existing literature on spontaneous carotid and vertebral artery dissections.
- Analysis of diagnostic modalities such as digital subtraction angiography (DSA), CT angiography (CTA), MR angiography (MRA), and ultrasonography.
- Examination of therapeutic interventions including antithrombotic agents, thrombolysis, and endovascular therapy.
Main Results:
- Spontaneous dissections are a significant cause of ischemic stroke, especially in younger populations.
- Digital subtraction angiography is the gold standard for diagnosis, with other imaging techniques serving complementary roles.
- The annual stroke risk post-dissection is low (approximately 1% or less).
Conclusions:
- Antithrombotic medication is the standard treatment, but lacks high-level evidence for guidance.
- The roles and efficacy of thrombolysis and endovascular therapies require further investigation.
- Further research is needed to establish evidence-based guidelines for managing spontaneous cerebrovascular dissections.
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