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

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.