Polyarterial clustered recurrence of cervical artery dissection seems to be the rule

Dittrich, Ralf; Naßenstein, I.; Bachmann, R.; Maintz, David; Nabavi, Darius G.; Heindel, Walter; Kuhlenbäumer, Gregor; Ringelstein, E. B.

doi:10.1212/01.wnl.0000265595.50915.1e

Cited by 85 publications

(43 citation statements)

References 36 publications

(42 reference statements)

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“…MRI-identified recurrent dissections were asymptomatic in 8 of 9 patients (89%); the other patient had a stroke thought to be the result of hemodynamic failure. 236 Only a few factors have been reported to have an association with an increased risk of recurrence. In an additional report based on the Mayo Clinic cohort, 50% of CDs with a positive family history had recurrence compared with only 6% of those without a positive family history.…”

Section: Risk Of Dissection or Stroke Recurrencementioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

175

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3155Purpose-Cervical artery dissections (CDs) are among the most common causes of stroke in young and middle-aged adults.The aim of this scientific statement is to review the current state of evidence on the diagnosis and management of CDs and their statistical association with cervical manipulative therapy (CMT). In some forms of CMT, a high or low amplitude thrust is applied to the cervical spine by a healthcare professional. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge. Results-Patients with CD may present with unilateral headaches, posterior cervical pain, or cerebral or retinal ischemia (transient ischemic or strokes) attributable mainly to artery-artery embolism, CD cranial nerve palsies, oculosympathetic palsy, or pulsatile tinnitus. Diagnosis of CD depends on a thorough history, physical examination, and targeted ancillary investigations. Although the role of trivial trauma is debatable, mechanical forces can lead to intimal injuries of the vertebral arteries and internal carotid arteries and result in CD. Disability levels vary among CD patients with many having good outcomes, but serious neurological sequelae can occur. No evidence-based guidelines are currently available to endorse best management strategies for CDs. Antiplatelet and anticoagulant treatments are both used for prevention of local thrombus and secondary embolism. Case-control and other articles have suggested an epidemiologic association between CD, particularly vertebral artery dissection, and CMT. It is unclear whether this is due to lack of recognition of preexisting CD in these patients or due to trauma caused by CMT. Ultrasonography, computed tomographic angiography, and magnetic resonance imaging with magnetic resonance angiography are useful in the diagnosis of CD. Follow-up neuroimaging is preferentially done with noninvasive modalities, but we suggest that no single test should be seen as the gold standard.

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Section: Risk Of Dissection or Stroke Recurrencementioning

confidence: 99%

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Biller¹,

Sacco²,

Albuquerque³

et al. 2014

Stroke

175

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“…All of these patients either had received heparin or had been anticoagulated orally with phenprocoumon, a regime that remained unchanged when the additional CAD occurred. In our study, we might have missed recurrences because of a shorter follow-up period, since Dittrich et al [22 ]reported recurrences in 3 patients at 1 week and in 3 other patients at 2 weeks. The relationship between AC and CAD recurrence needs to be confirmed by a longer follow-up period, beyond the first week.…”

Section: Discussionmentioning

confidence: 79%

Does Anticoagulation Promote Mural Hematoma Growth or Delayed Occlusion in Spontaneous Cervical Artery Dissections?

Machet¹,

Fonseca

Oppenheim³

et al. 2013

Cerebrovasc Dis

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Background: In case of spontaneous cervical artery dissection (CAD), a medical treatment with anticoagulant or antiplatelet (AP) drugs would avoid the occurrence of an ischemic stroke. Although immediate anticoagulation (AC) is advocated, evidence from randomized trials is lacking. Since CAD is characterized by a mural accumulation of blood, the dissecting hematoma may enlarge under AC, with subsequent lumen narrowing. Although direct evidence of mural hematoma enlargement is lacking in the literature, such a complication may not only be theoretical. Magnetic resonance imaging (MRI) of the mural hematoma on transverse sections through the neck is the current diagnostic gold standard. Our aim was to compare the evolution of the mural hematoma in CAD during the first week after treatment initiation (AP agent: group_AP, AC: group_AC), using dedicated cervical MRI of the arterial wall. Methods: The study was -approved by the Ethics Committee of Ile de France III. Informed consent was waived. The manuscript was prepared in accordance with the STROBE statement. Fast spin-echo T1-weighted fat-suppressed axial sequences were performed at admission (MRI₁) and during the first week after initiation of the treatment (MRI₂). Two readers measured volumes, craniocaudal length of the mural hematoma and lumen patency, and searched for early recurrent CAD. They also searched for extension or recurrence of ischemic brain lesions and for hemorrhagic transformation on diffusion-weighted imaging (DWI) and gradient echo T2 (T2*) sequences, respectively. Results: The population included 44 patients (31 in group_AC, 13 in group_AP) with 49 CAD (35 carotid, 14 vertebral). Recurrent CAD and reduction of the lumen did not occur in either group. We did not observe recurrent DWI lesions or occurrence of hemorrhagic transformation. Interobserver agreement [intraclass correlation coefficient (95% CI)] was excellent for volume measurement [0.98 (0.97-0.99) and 0.99 (0.98-1.0) for volume₁ and volume₂, respectively]. While mean volumes and length of the mural hematoma decreased after treatment in both groups (volume: group_AC -13 ± 22%, group_AP -12 ± 24%, p = 0.33; length: group_AC -10 ± 27%, group_AP -10 ± 20%, p = 0.18), approximately one third of patients in each group had some growth of the mural hematoma as well as an increase in length. Conclusion: Limited growth of the mural hematoma was seen with both treatments in approximately one third of patients during the first week after treatment initiation. However, neither AC nor AP agents promote reduction of the lumen or recurrent dissection.

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“…Despite the unclear association between puerperium and arterial dissection, transient wall abnormalities induced by postpartum hormonal changes have been suggested as explanations [7] . Recurrence of dissection is rare and more frequent within the first 2 months after the initial event, reinforcing the possibility of a transient vascular disorder [8] .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Multiple Cervical Artery Dissection in the Puerperium

Pires¹,

Geraldes²,

Neto³

et al. 2011

Cerebrovasc Dis

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Polyarterial clustered recurrence of cervical artery dissection seems to be the rule

Cited by 85 publications

References 36 publications

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Cervical Arterial Dissections and Association With Cervical Manipulative Therapy

Does Anticoagulation Promote Mural Hematoma Growth or Delayed Occlusion in Spontaneous Cervical Artery Dissections?

Spontaneous Multiple Cervical Artery Dissection in the Puerperium

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