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Published on: August 9, 2024

Possible Diagnostic Error in Cervical Artery Dissection: Analysis of STOP-CAD Study

Ekaterina Bakradze1, Liqi Shu2, Shadi Yaghi2

  • 1Department of Neurology University of Alabama at Birmingham Birmingham AL USA.

Journal of the American Heart Association
|May 14, 2026
PubMed

Insights

One in six patients with cervical artery dissection (CeAD) are misdiagnosed, often younger individuals with migraines or nonfocal symptoms. Early recognition of CeAD is crucial for timely stroke prevention and improved patient outcomes.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Diagnostic Accuracy

Background:

  • Cervical artery dissection (CeAD) is a leading cause of stroke in young adults.
  • Nonspecific symptoms frequently lead to misdiagnosis of CeAD.
  • Understanding factors contributing to diagnostic error is vital for improving patient outcomes.

Purpose of the Study:

  • To identify factors associated with diagnostic error in CeAD.
  • To evaluate the impact of diagnostic error on patient outcomes.

Main Methods:

  • Secondary analysis of the multicenter international STOP-CAD study.
  • Defined possible diagnostic error as CeAD symptoms within 30 days before diagnosis.
  • Used multivariable regression to identify associated factors and analyzed outcomes like ischemic stroke, death, and functional status.

Main Results:

  • 16.5% of 4012 patients experienced possible diagnostic error.
  • Patients with diagnostic error were younger, more likely to have migraines and headaches, and less likely to have focal neurologic signs.
  • No significant differences in post-diagnosis ischemic stroke, 90-day functional status, or death were observed between groups.

Conclusions:

  • Approximately 1 in 6 CeAD patients face diagnostic delays.
  • Younger age, history of migraines, and nonfocal symptoms are associated with diagnostic error.
  • Despite diagnostic delays, outcomes like stroke, functional status, and mortality were similar, suggesting potential resilience or effective management post-diagnosis.
Abstract

Keywords:
dissectionmisdiagnosisstroke

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