Craniocervical Artery Dissections: A Concise Review for Clinicians

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Craniocervical artery dissection (CAD) is an uncommon yet serious condition affecting young individuals.
• It involves a tear in the artery intima, leading to intramural hematoma formation.
• CAD can be spontaneous or triggered by minor trauma, and may be associated with connective tissue disorders.

Purpose of the Study:

• To provide a comprehensive overview of craniocervical artery dissection (CAD).
• To outline diagnostic strategies and management principles for CAD.
• To emphasize secondary stroke prevention and patient recommendations.

Main Methods:

• Review of current literature and clinical guidelines for CAD diagnosis and management.
• Emphasis on emergent evaluation using computed tomography angiography (CTA) or magnetic resonance imaging/angiography (MRA).
• Discussion of diagnostic limitations of carotid ultrasound and the role of catheter-based angiography.

Main Results:

• CAD can present with focal neurologic deficits (ischemia, stroke) or subarachnoid hemorrhage.
• Local symptoms like head/neck pain, pulsatile tinnitus, Horner syndrome, and cranial neuropathies are common.
• Acute stroke management follows general guidelines, with long-term antithrombotic therapy essential for secondary prevention.

Conclusions:

• Early diagnosis and appropriate management of CAD are critical to prevent devastating complications like stroke.
• Long-term antithrombotic therapy is recommended for secondary stroke prevention in CAD patients.
• Patients with CAD should avoid activities that may exacerbate the condition, such as forceful neck manipulation.