Risk factors, radiological features, and infarct topography of craniocervical arterial dissection
Lucy Caroline Thomas1, Darren A Rivett, Mark Parsons
1Faculty of Health, School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia.
Insights
Craniocervical arterial dissection, often linked to neck trauma, commonly affects the vertebral artery and can cause stroke. Radiological features, like dissection flaps, are associated with trauma and specific infarct patterns.
Area of Science:
- Neurology
- Vascular Imaging
- Stroke Medicine
Background:
- Craniocervical arterial dissection is a significant cause of ischemic stroke in younger to middle-aged adults.
- Previous studies have described radiological features but lacked detailed infarct mapping and risk factor correlation.
Purpose of the Study:
- To characterize the radiological findings in patients with craniocervical arterial dissection (≤55 years).
- To correlate these radiological features with patient risk factors.
Main Methods:
- Retrospective review of craniocervical arterial dissection cases (≤55 years) and age/gender-matched stroke controls (1998-2009).
- Analysis of medical records and radiological imaging to identify dissection characteristics and risk factors.
Main Results:
- Thirty-six dissection cases (20 vertebral, 16 internal carotid) and 43 controls were identified.
- Infarction occurred in 61% of dissection cases; intimal flaps were the most common finding.
- Neck trauma (64%) and vascular variants (36%) were significant risk factors.
Conclusions:
- Vertebral artery dissection is frequently associated with a history of neck trauma.
- Dissections are typically extracranial with upper cervical involvement and 28% showed intracranial extension.
- Trauma-related dissections often present with dissection flaps and specific infarcts, suggesting targeted imaging of the V3 vertebral artery segment or skull base for internal carotid artery is warranted.
Background:
Craniocervical arterial dissection is a common cause of ischemic stroke in the young to middle-aged population. There have been a number of previous studies where radiological features have been described but few with detailed mapping of infarct topography and none where these features have been related to the reported risk factors.
Aims:
The aims of this study were to describe the radiological characteristics of dissection patients ≤55 years and relate these to reported risk factors.
Methods:
Craniocervical arterial dissection cases ≤55 years, and age- and gender-matched controls were identified from a medical records database between 1998 and 2009. Control cases had stroke from another cause than dissection. Records and radiology were reviewed.
Results:
Thirty-six radiologically confirmed dissection cases [20 (56%) vertebral artery, 16 (44%) internal carotid], and 43 controls were identified. Dissections were extracranial with intracranial extension in 10 (28%) cases. Infarction was demonstrated in 22 (61%) dissection cases. The most common wall deficit identified was an intimal flap. Twenty-three (64%) dissection cases had a recent history of neck trauma (P > 0·000) and 13 (36%) had vascular variants (P = 0·013).
Conclusion:
Craniocervical arterial dissection cases, particularly vertebral artery, were more likely to have a history of neck trauma. Dissections were most commonly extracranial, in the upper cervical region, with intracranial extension in 28%. Dissection cases with trauma more commonly had a dissection flap and evidence of infarction in the lateral medulla, anterior or posterior inferior cerebellar artery territory. Close inspection of the V3 segment of the vertebral or skull base for internal carotid artery may be warranted with a history of neck trauma.
Related Concept Videos
01:15Ischemic Stroke l: Introduction
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:17Hemorrhagic Stroke l: Introduction
01:15Ischemic Stroke ll: Pathophysiology
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:26Transient Ischemic Attack l: Introduction