Postpartum Cervicocephalic Artery Dissection

Arnold, Marcel; Camus-Jacqmin, Mathilde; Stapf, Christian; Ducros, Anne; Viswanathan, Anand; Berthet, Karine; Bousser, Marie Germaine

doi:10.1161/strokeaha.107.510107

Cited by 92 publications

(119 citation statements)

References 14 publications

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“…Occurrence of arterial dissection has been observed by others in a minority of cases with cSAH though a direct causal relationship has not been established. 6,13,26 It is possible that edema of arterial wall and sudden surges in blood pressure predisposes to dissection.…”

Section: Recurrent Hemorrhage (Intracerebral Hemorrhage)mentioning

confidence: 99%

Atraumatic convexal subarachnoid hemorrhage

Kumar¹,

Goddeau²,

Selim³

et al. 2010

Neurology

246

146

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Objective: To identify patterns of clinical presentation, imaging findings, and etiologies in a cohort of hospitalized patients with localized nontraumatic convexal subarachnoid hemorrhage.Methods: Twenty-nine consecutive patients with atraumatic convexal subarachnoid hemorrhage were identified using International Classification of Diseases-9 code from 460 patients with subarachnoid hemorrhage evaluated at our institution over a course of 5 years. Retrospective review of patient medical records, neuroimaging studies, and follow-up data was performed.Results: There were 16 women and 13 men between the ages of 29 and 87 years. Two common patterns of presentations were observed. The most frequent presenting symptom in patients Յ60 years (n ϭ 16) was a severe headache (n ϭ 12; 75%) of abrupt onset (n ϭ 9; 56%) with arterial narrowing on conventional angiograms in 4 patients; 10 (p ϭ 0.003) were presumptively diagnosed with a primary vasoconstriction syndrome. Patients Ͼ60 years (n ϭ 13) usually had temporary sensory or motor symptoms (n ϭ 7; 54%); brain MRI scans in these patients showed evidence of leukoaraiosis and/or hemispheric microbleeds and superficial siderosis (n ϭ 9; 69%), compatible with amyloid angiopathy (n ϭ 10; p Ͻ 0.0001). In a small group of patients, the presentation was more varied and included lethargy, fever, and confusion. Four patients older than 60 years had recurrent intracerebral hemorrhages in the follow-up period with 2 fatalities. Conclusion:Convexal subarachnoid hemorrhage is an important subtype of nonaneurysmal subarachnoid bleeding with diverse etiologies, though a reversible vasoconstriction syndrome appears to be a common cause in patients 60 years or younger whereas amyloid angiopathy is frequent in patients over 60. These observations require confirmation in future studies. Atraumatic localized convexal subarachnoid hemorrhage (cSAH) is an unusual presentation of subarachnoid bleeding, in which the bleeding is localized to the convexities of the brain without involvement of the adjacent parenchyma or extension into the interhemispheric fissures, basal cisterns, or ventricles. Since most saccular aneurysms arise from the circle of Willis, aneurysmal rupture is an unlikely source of cSAH. Diverse etiologies have been posited for its occurrence, including cortical vein occlusions, posterior reversible leukoencephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), coagulopathy, cocaine use, lupus vasculitis, cavernoma, brain abscesses, and cerebral amyloid angiopathy (CAA). 1-13Existing information about this condition is largely derived from case reports and small case series, which carry inherent referral and diagnostic biases. We undertook this study to systematically evaluate and review the potential causes and patterns of clinical and radiologic presentation of localized cSAH from the inpatient population at our institution.

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Section: Recurrent Hemorrhage (Intracerebral Hemorrhage)mentioning

confidence: 99%

Atraumatic convexal subarachnoid hemorrhage

Kumar¹,

Goddeau²,

Selim³

et al. 2010

Neurology

246

146

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“…Although we did not find clinical evidence for sympathetic activation in our patient, the lack of Horner's syndrome would support this hypothesis. An association between RCVS and unilateral CAD has been noted in single case reports (3)(4)(5). However, in all of them concomitant more common causes of RCVS were present.…”

Section: Discussionmentioning

confidence: 87%

“…Carotid artery dissection (CAD) has been discussed as a rare possible cause. So far, only single cases of unilateral CAD and RCVS have been reported, although all of them in combination with other more common causes, such as exposure to vasoactive substances or postpartum period (3)(4)(5). Herein, we describe a patient with spontaneous bilateral CAD and concurrent RCVS.…”

Section: Introductionmentioning

confidence: 94%

Reversible cerebral vasoconstriction syndrome with concurrent bilateral carotid artery dissection

et al. 2013

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Background: The pathophysiological basis of reversible cerebral vasoconstriction syndrome is poorly understood but carotid artery dissection has been discussed as a rare possible cause. So far, only single cases of unilateral carotid artery dissection and reversible cerebral vasoconstriction syndrome have been reported. Case: Here, we describe the case of a 54-year old patient presenting to the emergency department with right hemiparesis, hypaesthesia and dysarthria. Furthermore, he reported two episodes of thunderclap headache after autosexual activity. Cerebral imaging showed ischaemic infarcts, slight cortical subarachnoid haemorrhage, bilateral carotid artery dissection and fluctuating intracranial vessel irregularities, compatible with reversible cerebral vasoconstriction syndrome. An extensive diagnostic work-up was normal. No typical trigger factors of reversible cerebral vasoconstriction syndrome could be found. The patient received intravenous heparin and the calcium channel blocker nimodipine. Followup imaging revealed no vessel irregularities, the left internal carotid artery was still occluded. Conclusion: This case supports the assumption that carotid artery dissection should be considered as a potential trigger of reversible cerebral vasoconstriction syndrome, possibly by altering sympathetic vascular tone.

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“…Dissection is much more common in extracranial segments of the carotid than it is in vertebral arteries. The most preferred site for intracranial carotid artery dissection is the supraclinoid segment beyond the origin of the ophthalmic artery, with or without extension to the MCA or ACA (3,16). It was observed that CCAD occurred more commonly in older child-bearing females and had a mean age of onset of 33,7 years (5-15) ( Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Unilateral headache and contralateral weakness are the most common neurological symptoms at the onset of disease. Generally, neurological symptoms appear within the first 24 hours but may occur later (3,24). The most common clinical presentations of CCAD are stroke or TIA, and intracranial haemorrhage is less common (4).…”

Section: Discussionmentioning

confidence: 99%

Dynamic Nature of Postpartal Carotid Artery Dissection

Vukicevic¹,

Brkić

Ducic³

et al. 2016

Serbian Journal of Experimental and Clinical Research

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ABBREVIATIONS CCAD -craniocervical carotid artery dissectionCTA -computed tomography angiography DSA -digital selective angiography ICA -internal carotid artery MRA -magnetic resonance angiography АBSTRACT Craniocervical carotid artery dissection (CCAD) is an important cause of stroke in young adults, but it has rarely been reported as a cause of stroke in puerperium.We We report the case of a 27-year-old female with a hi i is s sof migraine who presented with unilateral left hea ad a a atransient episodes of dysphasia and right hemipar r re r sis ys after vaginal delivery. Th e fi rst symptoms started ed ed d ed six after the pro o o ol lo lo lo l ng ng ng ged ed ed ed childbirth. Th e fi rst magnetic c c c c resoangiogra a a a ap p ph p p y revealed ed d ed d d d d d dis is is is issection in the sup p up up upra a ra rac clinoid cavern n n no o ou o s se se se se segm gm g g g en en nt t t t of of of of of t the lef f f ft t t t t In In In nte te ternal al al al a c carotid artery . We fo fo fo o foll ll ll l lo o ow o ed d d d up the pa a a ati t t t en n n nt t t t t for two years and she had stabl l le e e e e co o o our u u se. During this time e e e, , , she had occlusion of the clinoid segment of the left ICA, with caudal extension e ext x x x x ra r r r cranial segment and re eca a analisation one month T T Two w w w m m m m mon onth th ths s la la late ter, r, s she he he h h had ad ad i int ntrac cranial extension with ti i i i ion n n n o o o of f f the left anterior cere e ebr br bra a al artery. During this s s she s su s s s ff ff ff ff ffer e e ed from two stroke e e e es s s s w w wi w w th minimal neurologim mp pa p irme m me me ment nt nt nt t a a and good clinic ic ic ca a al r r r r recovery. The pathop p phy hy hy hy hysi si si iol ol l ol log o og og ogy y y of of of C C CCA CA CA CA AD D D D appears to be multifactoVessel el el w w w wal al a a l injury r l l l elated to the Valsalva manoeuvre durbour, as wel l ll l l l as as as a h h h hemodynamic and hormonal changes of ssel wall related to pre e e egn gn gn gn g an a cy in a patient with a history graine, may be causes of p p po p p stpartum spontaneous crarvical artery dissection in h h

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Postpartum Cervicocephalic Artery Dissection

Cited by 92 publications

References 14 publications

Atraumatic convexal subarachnoid hemorrhage

Atraumatic convexal subarachnoid hemorrhage

Reversible cerebral vasoconstriction syndrome with concurrent bilateral carotid artery dissection

Dynamic Nature of Postpartal Carotid Artery Dissection

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