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Clinical features and prognosis of intracranial artery dissection

Tineke Sikkema1, Maarten Uyttenboogaart, J Marc C van Dijk

  • 1*Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; ‡Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; §Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Neurosurgery
|February 26, 2015
PubMed

Insights

Intracranial artery dissections (IADs) outcomes are similar regardless of location or subarachnoid hemorrhage (SAH) presentation. Low Glasgow Coma Scale scores and older age predict poor outcomes in patients with IAD.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Neurosurgery

Background:

  • Intracranial artery dissections (IADs) are a significant cause of stroke and subarachnoid hemorrhage (SAH).
  • The prognosis of IADs in the anterior circulation and those without SAH is less understood.
  • Understanding these factors is crucial for effective patient management.

Purpose of the Study:

  • To analyze the clinical characteristics and prognosis of patients diagnosed with IAD.
  • To specifically investigate the impact of IAD location (anterior vs. posterior circulation) and clinical presentation (SAH vs. cerebral ischemia) on outcomes.
  • To identify independent predictors of functional outcome in IAD patients.

Main Methods:

  • A single-center cohort study included 60 patients with IAD between January 1998 and May 2012.
  • Clinical features, functional outcomes (using modified Rankin Scale), mortality, and prognostic factors were assessed.
  • Unfavorable functional outcome was defined as a modified Rankin Scale score of 3 to 6.

Main Results:

  • IADs in the anterior circulation occurred in 30% of patients, with similar unfavorable functional outcomes compared to the posterior circulation (35.3% vs. 39.0%).
  • Subarachnoid hemorrhage (SAH) was present in 70% of patients and was not significantly associated with poorer functional outcomes.
  • Low Glasgow Coma Scale score (OR, 0.72; P = .003) and older age (OR, 1.04; P = .04) were independent predictors of unfavorable functional outcome.

Conclusions:

  • Low Glasgow Coma Scale score on admission and advanced age are significant independent predictors of poor functional outcomes in patients with IAD.
  • The presence of SAH at presentation does not appear to be significantly associated with worse functional outcomes.
  • These findings aid in risk stratification and management strategies for intracranial artery dissections.
Abstract

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