Antiplatelets vs anticoagulation for dissection

Kennedy, Fiona; Lanfranconi, Silvia; Hicks, Cara; Reid, J. M.; Gompertz, Patrick; Price, Chris; Kerry, Sally; Norris, John W.; Markus, Hugh S.

doi:10.1212/wnl.0b013e318264e36b

Cited by 171 publications

(113 citation statements)

References 12 publications

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“…12 A recent meta-analysis combining data from the nonrandomized arm of CADISS with results from previous nonrandomized studies failed to provide clear guidance on the relative efficacy of anticoagulation compared with antiplatelet therapy in the prevention of stroke after acute extracranial carotid and vertebral artery dissection. 13 Because intracranial extension of the carotid artery dissection (as seen in our patient) increases the risk of subarachnoid hemorrhage, antiplatelet therapy tends to be preferred over anticoagulation. 3,4 Still, analysis of data from a large singlecentre registry indicated that patients with intracranial artery dissection without subarachnoid hemorrhage had a favourable outcome with anticoagulants.…”

Section: Management Of Carotid Dissectionmentioning

confidence: 85%

Sudden-onset anisocoria in a patient with upper respiratory tract infection

Furlan

Sundaram

2013

CMAJ

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Section: Management Of Carotid Dissectionmentioning

confidence: 85%

Sudden-onset anisocoria in a patient with upper respiratory tract infection

Furlan

Sundaram

2013

CMAJ

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“…There is currently no evidence for superiority of either therapy. 4 The Cervical Artery Dissection in Stroke e4 Stroke…”

Section: Discussionmentioning

confidence: 99%

Young Patient With Headache and Amaurosis Fugax

Saarela

Sundararajan

Strbian

2014

Stroke

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A 48-year-old male farmer with a past medical history of nonspecific headache experienced acute onset of throbbing headache centered over his forehead. About an hour later he acutely lost sight in his right eye, lasting for ≈5 minutes. When the severe headache continued, the patient's wife called an ambulance. In the ambulance, he received fentanyl for the headache but was otherwise normal. At the primary hospital an internist investigated the patient and the vision was found to be normal and no neurological deficit was detected. The patient received some more painkillers for presumed migraine. An hour later, the patient developed left-sided hemiparesis and he became slightly drowsy. Computed tomographic (CT) scan of the head revealed a hyperdense middle cerebral artery sign on the right. The patient was then transferred to a tertiary care center where a neurologist obtained a National Institutes of Health Stroke Scale of 11 (age wrong, left hand and foot drifted into the bed during 10/5 seconds, visual and tactile neglect, partial gaze deviation, sensory deficit in the left hand, and deficit in the left visual field). There were no contraindications for thrombolysis and the patient received the bolus of thrombolysis treatment 2 hours and 50 minutes from the development of hemiparesis. After the bolus administration, the patient underwent perfusion CT and CT angiography. The latter showed occlusion of the right middle cerebral artery corresponding to the hyperdense sign on the original CT. In addition, dissection of the right internal carotid artery was detected. Findings on perfusion CT indicated penumbra within the middle cerebral artery territory. Follow-up CT scan the next day showed brain infarction of a size slightly smaller than the lesion seen in CT perfusion imaging. The patient was eventually discharged to the rehabilitation ward, where his 30-day modified Rankin Scale was 4. The patient has a visual and tactile neglect, anosognosia, and he walks with assistance. He continues with physiotherapy, occupational therapy, and neuropsychologic rehabilitation. DiscussionTransitory blindness or blurred vision in 1 eye (amaurosis fugax) is a form of transient ischemic attack (TIA) localized within the eye. The symptom is caused by interruption of the ocular arterial circulation, usually lasting a few minutes. Classically amaurosis is caused by thromboembolism originating from an atherosclerotic plaque of the internal carotid artery; however, it can also be caused by embolization from the aorta, heart, local thrombosis of the vasculature of the optic nerve or the retina, or thromboembolism from carotid artery because of nonatherosclerotic causes including dissection. Amaurosis fugax is an emergency that requires a similar diagnostic workup as other TIAs.Carotid artery dissection (CAD) is common cause of stroke in young adults (<50 years) 1 and should be considered when previously healthy young individuals experience an ischemic stroke or TIA. Local signs and symptoms of CAD include head, facial, or neck pain, pa...

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“…9 However, this practice is not confirmed by nonrandomized studies and randomized trials are missing. 10 Moreover, anticoagulation has to be used carefully in case of extensive ischemic stroke due to hemorrhagic transformation risk, and subarachnoid hemorrhage, a potential complication of intracranial VAD, has to be looked for before any antithrombotic therapy can be proposed. 9 …”

Section: Discussionmentioning

confidence: 99%

Unilateral posterior cervical spinal cord infarction due to spontaneous vertebral artery dissection

Richard

Abdallah

Chanson

et al. 2013

The Journal of Spinal Cord Medicine

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Context: Ischemia of the cervical spinal cord is a rare complication of spontaneous vertebral artery dissection (VAD) and usually involves the ventral portion. We describe a less evocative clinical presentation and images of unilateral posterior spinal cord infarction due to spontaneous VAD in order to facilitate early diagnosis. Findings: A previously fit 30-year-old man presented with persistent headaches and proximal motor deficit of the right arm. He was diagnosed with spontaneous dissection of both vertebral arteries, with occlusion of the right one, and the right carotid artery. Neurological examination also revealed a right C2-C3 tactile sensory loss, with unilateral proprioceptive deficit below. Brain images revealed small bilateral cerebellar infarcts which could not be responsible for the clinical symptoms. Magnetic resonance imaging of the spinal cord showed a right posterior cervical spinal cord infarction. The patient achieved nearly complete recovery after several weeks of anticoagulation and rehabilitation. Conclusion and clinical relevance: Infarction of the caudal portion of the cervical spinal cord, especially unilateral, caused by spontaneous VAD, has rarely been described and is certainly under-diagnosed due to less suggestive symptoms, like unilateral and mainly sensory deficit. Nevertheless, early diagnosis of this condition is important to guide patient management and rehabilitation.

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Antiplatelets vs anticoagulation for dissection

Abstract: www.dissection.co.uk, ISRNCTN44555237.

Cited by 171 publications

References 12 publications

Sudden-onset anisocoria in a patient with upper respiratory tract infection

Sudden-onset anisocoria in a patient with upper respiratory tract infection

Young Patient With Headache and Amaurosis Fugax

Unilateral posterior cervical spinal cord infarction due to spontaneous vertebral artery dissection

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