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Are There Differences between Traumatic and Spontaneous Cervical Artery Dissections?
Issa Metanis1, Naaem Simaan1,2, Yoel Schwartzmann1
1Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel.
Insights
Spontaneous and traumatic cervical arterial dissections (CeAD) present differently, with traumatic cases showing less infarction but more hemorrhages. However, dissection subtype does not independently impact the likelihood of achieving functional independence after stroke.
Area of Science:
- Neurology
- Vascular Medicine
- Stroke Research
Background:
- Cervical arterial dissections (CeAD) are a significant cause of stroke in young adults.
- CeAD can be spontaneous (sCeAD) or traumatic (tCeAD), with distinct clinical and radiological profiles.
- Understanding differences between CeAD subtypes is crucial for targeted treatment and improved patient outcomes.
Purpose of the Study:
- To compare clinical, radiological, and outcome characteristics between spontaneous and traumatic cervical arterial dissections.
- To identify factors associated with favorable outcomes in patients with CeAD.
- To determine if dissection subtype independently influences functional recovery.
Main Methods:
- Retrospective analysis of 154 patients with CeAD, divided into sCeAD and tCeAD groups.
- Comparison of demographics, clinical features, risk factors, imaging findings, treatments, and 90-day outcomes.
- Logistic regression analysis to identify predictors of favorable outcome.
Main Results:
- sCeAD patients were older and more likely to have hyperlipidemia than tCeAD patients.
- tCeAD patients had less early infarction on imaging but more symptomatic intracranial hemorrhages.
- Favorable outcomes at 90 days were less common in tCeAD patients (78% vs. 97%).
- Age, stroke severity, vessel stenosis, and multi-vessel involvement predicted favorable outcome, not dissection subtype.
Conclusions:
- Cervical arterial dissection subtype (spontaneous vs. traumatic) does not independently predict functional independence.
- Clinical presentation and imaging findings differ significantly between sCeAD and tCeAD.
- Factors like initial stroke severity and age are key determinants of recovery in CeAD patients.
Abstract:
(1) Background: Cervical arterial dissections (CeAD) are a common cause of stroke in young adults. CeAD can be spontaneous (sCeAD) or traumatic (tCeAD). Whether CeAD subtypes differ in clinical, radiological, and outcome characteristics remains unexplored. (2) Methods: Patients with CeAD were identified and divided between sCeAD and tCeAD. Demographics, clinical features, risk factors, imaging findings, treatments, and outcomes were compared between the groups. Logistic regressions were used to determine characteristics associated with favorable outcome. (3) Results: Overall, 154 patients were included (106 sCeAD and 48 tCeAD). Patients with sCeAD were significantly older (mean ± SD 46 ± 12 vs. 35 ± 14, p < 0.001) and were more likely to have hyperlipidemia (19% vs. 4%, p = 0.016), but other risk factors did not differ. Patients with tCeAD less often had signs of early infarction on imaging (21% vs. 49%, p = 0.001) and had lower stroke severity on admission (NIHSS, median, interquartile range [IQR] 0 (0-9) vs. 2 (0-4), p = 0.012), but more often had symptomatic intracranial hemorrhages (12.5% vs. 2%, p = 0.006). Patients with tCeAD less often had favorable outcomes at 90 days (78% vs. 97%, p < 0.001). In the regression analysis, the only variables associated with favorable outcome were age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.03-1.24), initial stroke severity (OR 0.84, 95% CI 0.73-0.97), degree of vessel stenosis (OR 0.35, 95% CI 0.14-0.83), and involvement of multiple vessels on presentation (OR 0.04, 95% CI 0.02-0.70), whereas dissection subtype was not associated (OR 0.45, 95% CI 0.03-68.80). (4) Conclusions: Dissection subtype is not an independent modifier of the chances of attaining functional independence.
