Spontaneous intracranial artery dissection: risk factors, clinical features and imaging features

There remains a lack of epidemiological data and evidence regarding risk factors for intracranial arterial dissection (IAD) worldwide, making it difficult to make a more timely and accurate clinical diagnosis. We aimed to identify risk factors, clinical and imaging features of spontaneous IAD (sIAD) using a case-control design.

We collected data on sIAD patients admitted to Tongji Hospital in Wuhan, China from June 2017 to June 2024. Non-IAD ischemic stroke (IS) and non-IAD intracerebral hemorrhage (ICH) patients served as control groups. Logistic regression models analyzed the three data sets, with results expressed as odds ratio (OR) and 95% confidence interval (CI).

After screening, 71 patients with sIAD, 84 patients with non-IAD IS and 102 patients with non-IAD ICH were included in this study. The findings showed that the participants with diabetes had a lower likelihood of sIAD than non-IAD IS (OR = 0.145, 95%CI = 0.030-0.702). Compared with non-IAD ICH patients, individuals with sIAD had lower systolic blood pressure on admission (OR = 0.941, 95%CI = 0.900-0.983) and less likely to be young (OR = 0.911, 95%CI = 0.855-0.970). Serological data showed that compared with non-IAD ICH patients, elevated triglyceride (OR = 0.326, 95%CI = 0.179-0.594) were associated with the reduced likelihood of sIAD, whereas the opposite was true for uric acid levels (OR = 1.007, 95%CI = 1.000-1.014). In imaging, sIAD patients showed the largest number of arterial lumen dilatation, followed by stenosis with dilatation.

Diabetes may be associated with a reduced likelihood of sIAD. Differences in serologic markers may help in the differential diagnosis of sIAD from other cerebrovascular events.