Cervical dissection in emergency neurology: diagnostic and treatment algorithms

Abstract

The epidemiology of cervical artery dissection (CAD), which is often not thought to be the cause of ischemic stroke and transient ischemic attack (TIA), is discussed. The pathomorphology and pathogenesis of CAD, the key feature of which is the development of intramural hematoma, as well as predisposing conditions, triggers and associated conditions, in particular migraine, are reviewed. The clinical picture of diseases — local symptoms (headache and/ or neck pain, Horner’s syndrome, caudal cranial nerve involvement, cervical radicular syndrome, pulsatile tinnitus) and ischemic events (ischemic stroke or TIA) is presented. Modern approaches to urgent neuro- and angioimaging in CAD are reflected, including the possibilities of CT angiography (direct and indirect signs) and fat sat MRI (crescent symptom). Issues of reperfusion therapy (intravenous thrombolysis, thrombectomy and stenting) are discussed. The course of disease and secondary antithrombotic prophylaxis are analyzed.