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Spontaneous Multiple Cervical Artery Dissections Detected with High-Resolution MRI: A Prospective, Case-Series Study.

Aikaterini Foska1, Aikaterini Theodorou1, Maria Chondrogianni1

  • 1Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, 12462 Athens, Greece.

Journal of Clinical Medicine
|September 27, 2025
PubMed
Summary

High-resolution MRI effectively detects multiple cervical artery dissections (CAD) in young patients, aiding in risk stratification and treatment strategies for ischemic stroke. This imaging technique improves diagnosis and management of this condition.

Keywords:
MR-angiographycervical artery dissectionhigh-resolution vessel wall imagingischemic stroke

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Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • Cervical artery dissection (CAD) is a primary cause of ischemic stroke in young and middle-aged individuals.
  • High-resolution magnetic resonance imaging (MRI), specifically fat-saturated T1-weighted black-blood SPACE sequences, enables non-invasive diagnosis of multiple arterial dissections.

Purpose of the Study:

  • To evaluate the utility of high-resolution MRI in diagnosing spontaneous multiple cervical artery dissections.
  • To assess the clinical presentation, risk factors, and outcomes of patients with multiple CAD.

Main Methods:

  • Retrospective analysis of 95 patients with CAD diagnosed via high-resolution MRI over three years (2022-2025) across two stroke centers.
  • All patients underwent high-resolution MRI and MR-angiography; nine also had digital subtraction angiography (DSA).
  • Predisposing factors, symptoms, and treatment strategies were documented.

Main Results:

  • Eleven out of 95 patients (11.6%) were diagnosed with multiple CADs.
  • Commonly reported risk factors included trauma, chiropractic manipulation, intense exercise, influenza-like illness, and childbirth.
  • Cervicocranial pain, cerebral infarctions, and Horner's syndrome were frequent symptoms; stroke recurrence was low (1/8 patients) during follow-up.

Conclusions:

  • Specific high-resolution MRI sequences are highly effective for detecting multiple CADs in young patients.
  • Systematic use of these MRI sequences can improve diagnostic sensitivity, identify underlying vasculopathies, stratify stroke risk, and guide therapeutic decisions.