Extracranial and intracranial vertebral artery dissections: A comparison of clinical findings

Kobayashi, Hiromasa; Morishita, Takashi; Ogata, Toshiyasu; Matsumoto, Juntaro; Okawa, Masakazu; Higashi, Toshio; Inoue, Tatsuo

doi:10.1016/j.jns.2016.01.062

Cited by 18 publications

(22 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In another study, amongst 122 dissections, 7.4% were intracranial and 92.6% were extracranial [20,22] .…”

Section: Vascular Imagingmentioning

confidence: 91%

See 1 more Smart Citation

Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Günther¹,

Witte²,

Freesmeyer³

et al. 2016

Eur Neurol

View full text Add to dashboard Cite

Background/Aims: Vertebral artery dissection (VAD) is an important cause of ischemic stroke. In this observational study, clinical data, magnetic resonance (MR) and ultrasound (US) imaging findings and ischemic patterns were analyzed. Methods: Forty-seven patients with a diagnosis of VAD underwent clinical examination, US, MR of the brain and neck and MR angiography (MRA) of the cervical arteries. Vascular abnormalities and ischemic brain lesions were noted. Data were evaluated separately and compared for spontaneous and traumatic VAD subgroups. Results: The most common overall clinical symptom was vertigo followed by neck pain. In the traumatic subgroup, vertigo was relatively rare (p = 0.022). Most common MRA findings were vessel irregularity and vessel occlusions. Ischemic lesions occurred significantly more frequently after spontaneous than after traumatic VAD (p = 0.009). Unilateral VAD was significantly more common in non-dominant vertebral arteries (p < 0.001). Mortality after trauma was not only due to VAD complications but also due to other trauma-related injuries. Conclusion: The variability of MR and US imaging findings in patients with VAD is illustrated. The algorithm of management should be based on a multimodality approach involving patient history and clinical neurological examination. Several types of vessel abnormalities and ischemic lesion in diverse locations may point to arterial dissection, and the differential diagnosis of VAD must be kept in mind.

show abstract

“…In another study, amongst 122 dissections, 7.4% were intracranial and 92.6% were extracranial [20,22] .…”

Section: Vascular Imagingmentioning

confidence: 91%

“…In a study defining hypoplasia as a luminal diameter of ≤ 2 mm, HVA were identified in 35% of healthy people. Furthermore, a vertebral artery may be narrowed secondary to atherosclerotic changes, particularly in the elderly [20] . In previous studies, the left VA was dominant in the majority of patients [21,22] .…”

Section: Vascular Imagingmentioning

confidence: 99%

Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Günther¹,

Witte²,

Freesmeyer³

et al. 2016

Eur Neurol

View full text Add to dashboard Cite

show abstract

“…[ 1 2 ] Arterial dissection (AD) has long been known to be a cause of ischemic stroke,[ 2 ] and the vertebral artery (VA) and/or its branches are more likely to be involved in a dissection than the carotid artery in East Asian populations. [ 3 ] However, the clinical and radiological characteristics of patients with AD-related CI have rarely been reported in literature. [ 4 ] Since diagnostic delay is not uncommon in patients with CI,[ 5 6 ] early identification of AD-related CI by clinical characteristics may be beneficial not only for strokologists but also for primary care and emergency physicians.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics of cerebellar infarction due to arterial dissection

et al. 2018

View full text Add to dashboard Cite

Objectives and Background:Arterial dissection (AD) of the vertebral artery (VA) or its branches may cause ischemic stroke of the posterior circulation. However, clinical and radiological characteristics of patients with AD-related cerebellar infarction (CI) have rarely been reported.Methods:Forty-nine patients with CI admitted to our department from April 2008 to March 2015 were identified from our database. After dichotomization into the AD and non-AD group, their demographics and presenting symptoms were compared. Subsequently, a multivariate regression analysis was performed to identify variables that correlated with AD.Results:During the 7-year period, 14 and 35 patients were identified in the AD and non-AD group, respectively. The AD group was significantly younger than the non-AD group (55.0 ± 16.3 vs. 69.7 ± 10.7 years, P = 0.001) and was also more likely to experience acute pain at onset (86% vs. 17%, P < 0.001). Using a multivariate regression analysis, these two variables and the male sex were found to correlate with AD. AD was located in extracranial VA (n = 3); intracranial VA (n = 8); posterior inferior cerebellar artery (PICA) (n = 3); and superior cerebellar artery (n = 1). Identification of AD was delayed in one patient with an extracranial VA and one patient with a PICA dissection.Conclusions:AD was responsible for approximately 30% of CI in our cohort. Pain at onset may be a useful symptom to identify patients with AD-related CI. While intracranial VA was the most common location of AD, physicians should be aware of the possibility of extracranial VA or PICA dissection in patients with seemingly unremarkable radiological findings.

show abstract

“…It is thought that this biochemical milieu that is well recognized to cause maternal endothelial dysfunction makes the endothelial layer susceptible to intimal rupture [ 8 , 9 ]. Hypertensive surge is possibly a risk factor for dissections and it is thought that the vertebral artery is prone to the mechanical damage of hypertensive surge given its known vulnerability to traumatic injury [ 10 , 11 ]. In keeping with that, we observed that the onset of symptoms in our patients was closely related to a preceding surge in blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review

Shanmugalingam

Pour

Chuah

et al. 2016

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

BackgroundArterial dissection is a rare complication of pregnancy and puerperium. There have been reports of aortic, coronary and cervical artery dissection in association with preeclampsia, however, vertebral artery dissection is rarely reported particularly in the antenatal setting in the presence of a Hypertensive Disorder of Pregnancy (HDP).The general annual incidence of symptomatic spontaneous cervicocephalic arterial dissection is 0.0026 % and a data registry reported that 2.4 % of these occurred in the post-partum period. The actual incidence of vertebral artery dissection in HDP is unknown as the current literature consists of case series and reports only with most documenting adverse outcomes. Given the presence of collateral circulation, unilateral vertebral artery dissections may go unrecognised and may be more common than suspected.Case presentationWe present a case series of four patients with vertebral artery dissection in association with HDP, two of which occurred in the antenatal setting and two in the post-partum setting. All our patients had favourable outcome with no maternal neurological deficit and live infants. Our discussion covers the proposed pathophysiology of vertebral artery dissection in HDP and the management of it.ConclusionOur case series highlights the need to consider VAD an important differential diagnosis when assessing pregnant women with headache and neck pain particularly in the context of HDP

show abstract

Extracranial and intracranial vertebral artery dissections: A comparison of clinical findings

Cited by 18 publications

References 11 publications

Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Clinical characteristics of cerebellar infarction due to arterial dissection

Vertebral artery dissection in hypertensive disorders of pregnancy: a case series and literature review

Contact Info

Product

Resources

About