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High risk and low prevalence diseases: Spontaneous cervical artery dissection
Brit Long1, Jessica Pelletier2, Alex Koyfman3
1Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
Insights
Spontaneous cervical artery dissection (sCAD) is a serious condition affecting neck arteries. Early diagnosis and management in the emergency department are crucial for improving outcomes in patients with sCAD.
Area of Science:
- Neurology
- Vascular Medicine
- Emergency Medicine
Background:
- Spontaneous cervical artery dissection (sCAD) is a critical condition with significant morbidity and mortality.
- It involves injury to the carotid or vertebral arteries, potentially leading to stroke or subarachnoid hemorrhage.
Purpose of the Study:
- To review the key aspects of sCAD diagnosis and management in the emergency department (ED).
- To highlight critical information for emergency clinicians regarding sCAD presentation, diagnosis, and treatment.
Main Methods:
- Review of current evidence on spontaneous cervical artery dissection.
- Focus on presentation, diagnostic modalities, and therapeutic strategies relevant to the ED setting.
Main Results:
- sCAD commonly presents with headache or neck pain, and can manifest as transient ischemic attack or stroke.
- Computed tomography angiography is the primary diagnostic tool; ultrasound is less reliable for exclusion.
- Management involves specialist consultation, antithrombotic therapy, and symptomatic treatment.
Conclusions:
- Understanding sCAD is vital for emergency physicians to ensure timely and accurate diagnosis.
- Effective management in the ED can mitigate the high risks associated with sCAD.
Introduction:
Spontaneous cervical artery dissection (sCAD) is a serious condition that carries with it a high rate of morbidity and mortality.
Objective:
This review highlights the pearls and pitfalls of sCAD, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.
Discussion:
sCAD is a condition affecting the carotid or vertebral arteries and occurs as a result of injury and compromise to the arterial wall layers. The dissection most commonly affects the extracranial vessels but may extend intracranially, resulting in subarachnoid hemorrhage. Patients typically present with symptoms due to compression of local structures, and the presentation depends on the vessel affected. The most common symptom is headache and/or neck pain. Signs and symptoms of ischemia may occur, including transient ischemic attack and stroke. There are a variety of risk factors for sCAD, including underlying connective tissue or vascular disorders, and there may be an inciting event involving minimal trauma to the head or neck. Diagnosis includes imaging, most commonly computed tomography angiography of the head and neck. Ultrasound can diagnose sCAD but should not be used to exclude the condition. Treatment includes specialist consultation (neurology and vascular specialist), consideration of thrombolysis in appropriate patients, symptomatic management, and administration of antithrombotic medications.
Conclusions:
An understanding of sCAD can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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