on behalf of the Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) GroupBackground-Little is known about the risk factors for cervical artery dissection (CEAD), a major cause of ischemic stroke (IS) in young adults. Hypertension, diabetes mellitus, smoking, hypercholesterolemia, and obesity are important risk factors for IS. However, their specific role in CEAD is poorly investigated. Our aim was to compare the prevalence of vascular risk factors in CEAD patients versus referents and patients who suffered an IS of a cause other than CEAD (non-CEAD IS) in the multicenter Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study. Methods and Results-The study sample comprised 690 CEAD patients (mean age, 44.2Ϯ9.9 years; 43.9% women), 556 patients with a non-CEAD IS (44.7Ϯ10.5 years; 39.9% women), and 1170 referents (45.9Ϯ8.1 years; 44.1% women). We compared the prevalence of hypertension, diabetes mellitus, hypercholesterolemia, smoking, and obesity (body mass index Ն30 kg/m 2 ) or overweightness (body mass index Ն25 kg/m 2 and Ͻ30 kg/m 2 ) between the 3 groups using a multinomial logistic regression adjusted for country of inclusion, age, and gender. Compared with referents, CEAD patients had a lower prevalence of hypercholesterolemia (odds ratio 0.55; 95% confidence interval, 0.42 to 0.71; PϽ0.0001), obesity (odds ratio 0.37; 95% confidence interval, 0.26 to 0.52; PϽ0.0001), and overweightness (odds ratio 0.70; 95% confidence interval, 0.57 to 0.88; Pϭ0.002) but were more frequently hypertensive (odds ratio 1.67; 95% confidence interval, 1.32 to 2.1; PϽ0.0001). All vascular risk factors were less frequent in CEAD patients compared with young patients with a non-CEAD IS. The latter were more frequently hypertensive, diabetic, and current smokers compared with referents. Conclusion-These results, from the largest series to date, suggest that hypertension, although less prevalent than in patients with a non-CEAD IS, could be a risk factor of CEAD, whereas hypercholesterolemia, obesity, and overweightness are inversely associated with CEAD. 4 -7 However, their specific impact on the occurrence of CEAD is poorly understood. Indeed, although the relationship of CEAD with vascular risk factors has been investigated in the past, studies were performed in small cohorts, 8 -19 and only 2 studies were specifically designed to assess this relationship. 16,19 A few studies reported a lower prevalence of vascular risk factors in CEAD patients compared with young patients with an IS of a cause other than CEAD (non-CEAD IS), 8 -10 whereas others did not observe any significant association. [11][12][13][14] Studies including referents are scarce [15][16][17]19 and yielded contradictory results: 1 study found no association 17 ; another observed a lower body mass index (BMI) 19 ; and 2 other studies found an increased prevalence of hypertension in CEAD patients compared with referents. 15,16 Clinical Perspective on p 1544The aim of the present analysis was to compare the prevalence of vascular ri...

BACKROUND AND PURPOSE:The optimal imaging method for the diagnosis of VAD remains undefined. Our aim was to evaluate the added value of HR-MR imaging for the diagnosis of VAD. MATERIALS AND METHODS:We retrospectively extracted 35 consecutive patients suspected of having acute VAD who had the following: 1) a focal lumen abnormality of the VA on CE-MRA, 2) HR-MR imaging during the initial hospital stay, and 3) clinical and imaging follow-up within 6 months. Two neurologists classified patients as either VAD (group A) or non-VAD (group B) by reviewing all the available data at hospital discharge, except HR-MR imaging data. On HR-MR imaging, 2 radiologists searched for signs of acute VAD. The 2 classifications were compared. In case of discordance, CE-MRA follow-up and axial fat-suppressed T1WI, used to obtain supportive evidence for or against VAD, were considered as the standard of reference. RESULTS:In 4/18 patients in group A, HR-MR imaging did not demonstrate any signs of acute VAD and perivertebral signal-intensity changes were attributed to venous plexus, with an unchanged lumen on follow-up. In 4/17 patients in group B, HR-MRI demonstrated a mural hematoma, with lumen normalization on follow-up CE-MRA. CONCLUSIONS:Our results encourage the use of HR-MR imaging as a second-line diagnostic tool in the event of suspicion of acute VAD and doubtful findings on standard imaging.ABBREVIATIONS: CE-MRA ϭ contrast-enhanced MR angiography; CI ϭ confidence interval; DSA ϭ digital subtraction angiography; DUS ϭ Doppler ultrasonography examination; DWI ϭ diffusionweighted imaging; HR ϭ high resolution; NIHSS ϭ National Institutes of Health Stroke Scale; PDWI ϭ proton attenuationϪweighted imaging; T1WI ϭ T1-weighted imaging; T2WI ϭ T2-weighted imaging; TE eff ϭ effective echo-time; TOF ϭ time of flight; V2 and V3 ϭ the second and third VA segments; VA ϭ vertebral artery; VAD ϭ VA dissection

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