Aspirin versus anticoagulation in intra‐ and extracranial vertebral artery dissection

Araúz, Antonio; Ruíz, Angélica; Pacheco, Gerónimo; Rojas, Pedro Navarro; Rodríguez-Armida, María; Cantú, Carlos; Murillo-Bonilla, Luis Manuel; Ruiz-Sandoval, José Luís; Barinagarrementería, Fernando

doi:10.1111/j.1468-1331.2012.03825.x

Cited by 45 publications

(50 citation statements)

References 17 publications

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“…In a series of 195 patients with vertebral artery dissections who were recruited in neurology departments in France and Switzerland, only 11% of dissections were located exclusively in the intracranial portion of the artery. 17 In a Mexican study 18 of 100 patients admitted to a neurology department for vertebral artery dissection with ischaemic stroke and without subarachnoid haemor rhage, 27 (27%) patients had intracranial artery dissection. In studies undertaken in east Asia, [19][20][21][22][23] in which patients were mostly recruited through neuro surgery and interventional neuroradiology departments, intracranial artery dissection Review accounted for up to 67-78% of all cervicocephalic artery dissections.…”

Section: Epidemiologymentioning

confidence: 99%

Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection

Debette¹,

Compter²,

Labeyrie³

et al. 2015

The Lancet Neurology

362

351

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Spontaneous intracranial artery dissection is an uncommon and probably underdiagnosed cause of stroke that is defi ned by the occurrence of a haematoma in the wall of an intracranial artery. Patients can present with headache, ischaemic stroke, subarachnoid haemorrhage, or symptoms associated with mass eff ect, mostly on the brainstem. Although intracranial artery dissection is less common than cervical artery dissection in adults of European ethnic origin, intracranial artery dissection is reportedly more common in children and in Asian populations. Risk factors and mechanisms are poorly understood, and diagnosis is challenging because characteristic imaging features can be diffi cult to detect in view of the small size of intracranial arteries. Therefore, multimodal follow-up imaging is often needed to confi rm the diagnosis. Treatment of intracranial artery dissections is empirical in the absence of data from randomised controlled trials. Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics. Prognosis seems worse in patients with subarachnoid haemorrhage than in those without.

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Section: Epidemiologymentioning

confidence: 99%

Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection

Debette¹,

Compter²,

Labeyrie³

et al. 2015

The Lancet Neurology

362

351

View full text Add to dashboard Cite

show abstract

“…The results of the meta-analysis and a recent observational results in cervical artery dissection cases have demonstrated that there is no superiority of anticoagulation over aspirin in the odds of death or the occurrence of ischemic stroke [64,65]. In our cases, we applied antiplatelet therapy, no patients had a hemorrhagic complication, and all patients did well on the mRS during a 3-month follow-up period.…”

Section: Discussionmentioning

confidence: 95%

Symptomatic unruptured isolated middle cerebral artery dissection: clinical and magnetic resonance imaging features

et al. 2014

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“…Generally, patients are initially treated with heparin, followed by warfarin or antiplatelet therapy alone (aspirin or aspirin and clopidogrel) (6,8). A study by Arauz et al compared treatment with oral anticoagulation versus aspirin alone and found that the incidence of recurrent ischemic stroke in patients with a vertebral artery dissection is low and likely independent of the type of antithrombotic treatment (9). However, how early the diagnosis is made and the severity of the sequelae may determine the best mode of therapy.…”

Section: Discussionmentioning

confidence: 99%

Vertebral Artery Dissection After a Chiropractor Neck Manipulation

Jones¹,

Jones²,

Nugent³

2015

Baylor University Medical Center Proceedings

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The differential diagnosis for ischemic central nervous system infarcts in young patients includes paradoxic emboli through cardiac shunts, vasculitis, and vascular trauma. We report a young woman who developed headache, vomiting, diplopia, dizziness, and ataxia following neck manipulation by her chiropractor. A computed tomography scan of the head revealed an infarct in the inferior half of the left cerebellar hemisphere and compression of the fourth ventricle causing moderate acute obstructive hydrocephalus. Magnetic resonance angiography revealed severe narrowing and low flow in the intracranial segment of the left distal vertebral artery. The patient was treated with mannitol and a ventriculostomy and had an excellent functional recovery. This report illustrates the potential hazards associated with neck trauma, including chiropractic manipulation. The vertebral arteries are at risk for aneurysm formation and/or dissection, which can cause acute stroke. Y oung patients may develop central nervous system infarcts following cardioembolic events, paradoxic emboli through intracardiac shunts, vasculitis, and vascular trauma in the neck. We describe a patient who developed posterior circulation symptoms following chiropractic manipulation of her neck. Th is case illustrates the hazards associated with neck manipulation and the potential for good outcomes in these patients if they develop a stroke syndrome. CASE DESCRIPTIONA 38-year-old female schoolteacher with no signifi cant past medical history presented with headache, nausea, vomiting, blurred vision, diplopia, dizziness, and ataxia for 2 to 3 weeks. Th ese symptoms started after a visit to her chiropractor and neck manipulation. Her symptoms were further exacerbated by hanging decorations from the ceiling at work. Her level of consciousness gradually decreased over the same time period. She was not taking any medications on admission and denied allergies and use of tobacco, alcohol, or illicit drugs. She was married and had two children. On examination, she was drowsy but aroused with sternal rubs. Her temperature was 97.6°F; heart rate, 71 beats per minute; blood pressure, 144/92 mm Hg; and respiratory rate, 18 breaths per minute. She was disoriented and followed simple commands poorly. She demonstrated nystagmus to the left. She moved all extremities but had left-sided weakness (3/5) with hyperrefl exia. Cardiac, respiratory, and abdominal examinations were within normal limits. Her white blood cell count was 13 k/μL; hemoglobin, 13.7 g/dL; and platelets, 286 k/μL. Renal and liver function tests, electrolytes, and coagulation times were within normal limits.A computed tomography (CT) scan of her head performed on admission showed a non-contrast-enhancing process involving the inferior half of the left cerebellar hemisphere (Figure 1a). Th ere was extensive mass eff ect with displacement, distortion, and compression of the fourth ventricle causing moderate acute obstructive hydrocephalus and displacement of the cerebellar vermis to the right. Th ere was mil...

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Aspirin versus anticoagulation in intra‐ and extracranial vertebral artery dissection

Abstract: Although this was a non-randomized study, our data suggest that the frequency of recurrent ischaemic stroke in patients with intra- or extracranial VAD is low and most likely independent of the type of antithrombotic treatment.

Cited by 45 publications

References 17 publications

Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection

Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection

Symptomatic unruptured isolated middle cerebral artery dissection: clinical and magnetic resonance imaging features

Vertebral Artery Dissection After a Chiropractor Neck Manipulation

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