Local Signs and Symptoms in Spontaneous Cervical Artery Dissection: A Single Centre Cohort Study

Mayer, Lukas; Boehme, Christian; Toell, Thomas; Dejakum, Benjamin; Willeit, Johann; Schmidauer, Christoph; Berek, Klaus; Siedentopf, Christian; Gizewski, Elke R.; Ratzinger, Gudrun; Kiechl, Stefan; Knoflach, Michael

doi:10.5853/jos.2018.03055

Cited by 19 publications

(25 citation statements)

References 9 publications

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“…Details of patient selection and recruitment methods for the ReSect-study have been published previously ( 3 , 11 ). In short, a retrospective chart review of all subjects that suffered CeAD between 1998 and 2015 and were treated at the Medical University of Innsbruck was performed in December of 2015.…”

Section: Methodsmentioning

confidence: 99%

“…The clinical presentation of spontaneous cervical artery dissection (sCeAD) includes a variety of symptoms ranging from local signs and symptoms, attributable to the local mass effect of the mural hematoma, to secondary TIA or ischemic stroke ( 1 – 3 ). As demonstrated previously, head/neck pain is the most frequent local sign and well-recognised to be one of the primary symptoms in sCeAD, commonly preceding cerebral ischemia ( 2 – 6 ). Yet, detailed pain assessments are scarce and information on specific clinical patterns in sCeAD-related head/neck pain are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Head/neck pain characteristics after spontaneous cervical artery dissection in the acute phase and on a long-run

et al. 2022

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Objective Head/neck pain is one of the primary symptoms associated with spontaneous cervical artery dissection. Still, data on pain quality, intensity, and long-term dynamics are scarce. Methods Spontaneous cervical artery dissection subjects were included if mural hematoma was visualised through T1 fat-saturated MRI at baseline. All available medical records were evaluated and patients were invited to standardised clinical follow-up visits at least 1 year after the index event. Results In total, 279 subjects were included in the ReSect-study with head/neck pain being the most frequent symptom of spontaneous cervical artery dissection (220 of 273, 80.6%). Pain was of pulling nature in 107 of 218 (49.1%), and extended to the neck area in 145 of 218 (66.5%). In those with prior headache history, pain was novel in quality in 75.4% (42 of 55). Median patient-reported pain intensity was 5 out of 10 with thunderclap-type headache being uncommon (12 of 218, 5.5%). Prior to hospital admission, head/neck pain rarely responded to self-medication (32 of 218, 14.7%). Characteristics did not differ between subjects with and without cerebral ischemia. Pain resolved completely in all subjects within a median of 13.5 days (IQR 12). Upon follow-up in 42 of 164 (25.6%) novel recurring headache occurred, heterogeneous in quality, localisation and intensity. Conclusion We present an in-depth analysis of spontaneous cervical artery dissection-related head/neck pain characteristics and its long-term dynamics.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Head/neck pain characteristics after spontaneous cervical artery dissection in the acute phase and on a long-run

et al. 2022

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“…Overall, as the endpoint occurred in about one in four patients receiving an antiplatelet agent and only one in seven under anticoagulation (absolute difference 8% [95% CI -4-21], non-inferiority p = 0.55) the authors concluded that noninferiority of aspirin compared to vitamin K-antagonists could not be established. As these data also do not incorporate the hyper-acute phase of CeAD, stroke guideline statements could not define specific treatment recommendations, which is unfortunate as most ischemic events post-CeAD occur during the first couple of days [11,59,60]. Solely the German society argues that similarly to subjects with multiple recurrent ischemic attacks or strokes or low flow-situations with a high risk of intraluminal thrombus formation, anticoagulation can be considered with an initial bridging using unfractionated or low-molecular-weight heparin.…”

Section: Medical Treatment -Antiplatelet Agents and Anticoagulationmentioning

confidence: 99%

“…In the case of post-dissection aneurysms, recent reports have presented cases in which stent-graft repair was able to reliably manage these vascular pathologies [86]. Still, conservative (medical) treatment is recommended by the German guidelines, which is supported by the current evidence in literature [59,70,87].…”

Section: Endovascular Management -Stentingmentioning

confidence: 99%

Disparities between guideline statements on acute and post-acute management of cervical artery dissection

Mayer¹,

Peball²,

Komarek³

et al. 2022

Rev. Cardiovasc. Med.

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Even though cervical artery dissection is one of the main reasons for ischemic stroke in young patients, acute management and postacute primary or secondary prevention of cerebral ischemia differ significantly in different centers and countries. These discrepancies are reflected by the differences in guideline recommendations of major stroke societies. Our narrative review aims to shed light on the different recommendations in guideline-statements of stroke societies and to give an overview of the current literature concerning acute management and post-acute treatment of cervical artery dissection patients. In general, intravenous thrombolysis and mechanical thrombectomy are recommended, irrespective of stroke etiology, if administered within the label. Secondary prevention of cerebral ischemia can be achieved by antiplatelet intake or anticoagulation, with, to date, neither treatment establishing superiority over the other. Duration of antithrombotic treatment, statin use as well as optimal endovascular approach are still up for debate and need further evaluation. Additionally, it is still unknown, whether the recommendations given in any of the guideline statements are similarly relevant in spontaneous and traumatic cervical artery dissection, as none of the stroke societies differentiates between the two.

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“…In this research we use the data of patients suffering a spontaneous cervical artery dissection until 2017, who were treated at the Department of Neurology, Medical University of Innsbruck, within the ReSect-study [3]. We selected the data of 10 patients with stenotic cervical artery dissection at the study baseline (date A).…”

Section: Information Collectionmentioning

confidence: 99%

Stenosis Detection in Internal Carotid and Vertebral Arteries With the Use of Diameters Estimated from MRI Data

Nesteruk

Pereverzyev

Mayer

et al. 2020

Innov Biosyst Bioeng

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Background. Magnetic resonance imaging (MRI) offers the opportunity to quantify the vessel diameters in vivo. This technique can have a breakthrough impact on the evaluation, risk stratification and therapeutical planning in hemodynamic-related pathologies, e.g., arterial stenosis. However, its applicability in clinics is limited due to the complex post-processing required to extract the information and the difficulty to synthesize the obtained data into clinical useful parameters. Objective. In this work, we use the vessel diameter distribution along its central line obtained with the use of MRI technology in order to detect the existence of stenosis in internal carotid arteries (ICA) and vertebral arteries (VA) with the minimal amount of False Negative predictions and to estimate the efficiency of therapy. Methods. Special normalized and smoothed characteristics will be used to develop the stenosis detection criteria which can be used for every artery separately and for both vessels simultaneously. Linear and non-linear characteristics were used to increase the reliability of diagnostics. Study is based on the Receiver Operating Characteristics (ROC) and optimization methods. Real diameter data of 10 patients (80 data sets) were used. Results. To detect stenosis, three different criteria have been proposed, based on the optimal smoothing parameters of vessel diameter distributions and the corresponding threshold values for linear and nonlinear characteristics. The use of the developed criteria allows increasing the reliability of stenosis detection. Conclusions. Different linear, non-linear, smoothed and non-smoothed parameters and ROC were applied to detect stenosis in internal carotid and vertebral arteries. It was shown that smoothed data are necessary for VA and the criterion applicable both for VA and ICA. For ICA it is possible to use initial (unsmoothed) data. Only one False Positive case was detected for every artery. Results of application of proposed criteria are presented, tested and discussed. For VA it is possible to use criteria 1 and 2 and smoothed normalized diameter data. For ICA criterion 2 can be recommended to detect long enough narrowing areas. To detect short zones of stenosis in ICA, the criterion 3 is useful, since it uses the non-smoothed diameter data.

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Local Signs and Symptoms in Spontaneous Cervical Artery Dissection: A Single Centre Cohort Study

Cited by 19 publications

References 9 publications

Head/neck pain characteristics after spontaneous cervical artery dissection in the acute phase and on a long-run

Head/neck pain characteristics after spontaneous cervical artery dissection in the acute phase and on a long-run

Disparities between guideline statements on acute and post-acute management of cervical artery dissection

Stenosis Detection in Internal Carotid and Vertebral Arteries With the Use of Diameters Estimated from MRI Data

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