Spontaneous cervical artery dissection: an update on clinical and diagnostic aspects

Campos-Herrera, Cynthia Resende; Scaff, Milberto; Yamamoto, Fábio Iuji; Conforto, Adriana Bastos

doi:10.1590/s0004-282x2008000600036

Cited by 28 publications

(35 citation statements)

References 62 publications

(163 reference statements)

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“…The arterial segment between these two points of anchorage is mobile and therefore vulnerable to stretching, especially during neck hyperextension with head rotation, which can stretch the ICA against an upper cervical vertebra or a prominent styloid process. The strain often occurs around 3 cm above the carotid bifurcation [5]. Usually, patients who experience cervical artery dissection or rupture might report either precipitating events or prior minor neck trauma [9], even if a clear cause-effect relationship is still debatable [10].…”

Section: Discussionmentioning

confidence: 99%

“…Cervicocephalic arterial dissections and rupture could be traumatic or spontaneous, and they could follow mild efforts as head and neck maneuvering, forceful cough and vomiting [4]. Few authors report a syndrome called ''spontaneous cervical arterial dissection (SCAD)'', used to describe a nontraumatic tear or disruption in the wall of the brain-supplying arteries [5].…”

Section: Introductionmentioning

confidence: 99%

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Spontaneous internal carotid artery rupture during neck dissection in osteogenesis imperfecta patient

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spontaneous internal carotid artery rupture during neck dissection in osteogenesis imperfecta patient

et al. 2015

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“…İnternal karotis arter diseksiyonu için söz konusu lokalizasyon bifurkasyondan 3 cm yukarısındadır. Bu segment, boyun hiperekstansiyonda baş rotasyonu ile ortaya çıkan gerilmeye karşı özellikle hassastır (7).…”

Section: Discussionunclassified

A case of carotid artery dissection devoleped after swimming: The role of heterezygote C677T MTHFR gen mutation

Ersoy¹,

Koç²,

Düzgün³

et al. 2013

Türk Beyin Damar Hast Derg

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Genç serebral inme sebepleri arasında karotis arter diseksiyonu önemli bir yer tutmaktadır. Karotis arter diseksiyonu çoğu zaman spontan olarak gelişmesine rağmen hasta tarafından önemsenmeyen mikro-travmaya bağlı da ortaya çıkabilir. Bu yazıda eforlu yüzme sonrasında gelişen, sadece boyun ağrısı ve boyunda pulsatil şişlikle kliniğimize başvuran, ancak yapılan ileri tetkiklerinde kronik venöz sinüs trombozu ve serebral enfarktüsün de olduğu ortaya çıkan ekstrakranial internal karotis arter diseksiyonlu bir olgu sunulmaktadır. MTHFR gen mutasyonu da saptanan olgu multipl vasküler olayların bir arada nadir görülmesi nedeniyle sunuldu. Anahtar Sözcükler: Karotis arter diseksiyonu, venöz sinüs trombozu, serebral enfarkt, MTHFR gen mutasyonu, yüzme. A CASE OF CAROTID ARTERY DISSECTION DEVOLEPED AFTER SWIMMING: THE ROLE OF HETEREZYGOTE C677T MTHFR GEN MUTATION ABSTRACTCarotid artery dissection is one of the most important causes of cerebral stroke in young age. Although most cases of carotid artery dissection appear spontaneously, sometimes it may result from a microtrauma which the patient doesn't take it seriously. This article reports a case of extracranial internal carotid artery dissection starting from intense swimming and manifesting itself only as neck swelling and neck pain. Other analyses showed that the patient also suffered from a cronic venous sinus thrombosis and stroke. Moreover, genetic testing revealed a MTHFR gene mutation. This case is presented because of the multiple vascular events are seen rarely in the same patient. Key Words: Carotid artery dissection, venous sinus thrombosis, cerebral infarction, MTHFR gene mutation, swimming. GİRİŞKarotis arter diseksiyonu (KAD) genç ve orta yaştaki hastalarda inme etiyolojisinde büyük önem taşımaktadır. İnsidansı 100 000'de 2.6-2.9'dur (1). Tüm yaşlarda görülmesine rağmen en sık beşinci dekatta rastlanır. Erkeklerde hafif predominansi oluşturmakla birlikte (% 56), kadınlarda 5 yaş daha erken ortaya çıkmaktadır (2, 3).En sık görülen diseksiyon tipi eksternal karotis arter diseksiyonudur. Klinik tablo çok hafif belirtilerden (ipsilateral baş ve boyun ağrısı, Horner sendromu) geçici iskemik ataklar (İA) ve serebral iskemiye bağlı ağır bulgulara kadar değişebilir. TİA ve serebral iskemi karotis arter diseksiyonu gelişen olguların % 49-84'ünde görülmektedir (2). Başlıca iskemi gelişme mekanizması diseksiyon yerinde oluşan trombüsten serebral arterlere olan embolidir. Hemodinamik değişiklikler patolojik mekanizmada daha az oranda rol oynamaktadır (4).KAD tanısında renkli doppler ultrasonografi, magnetik rezonans anjiografi (MRA), bilgisayarlı tomografi anjiografi (BTA) ve dijital substraksiyon _____________________________________________________________________________________________________________________________

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“…It has been hypothesized that an underlying arteriopathy leading to ultrastructural abnormalities and arterial weakness is likely present, increasing susceptibility to dissections in affected subjects 2,3,4 . However, cervical dissections are often diagnosed in the absence of prior mechanical triggers.…”

mentioning

confidence: 99%

“…Dissections that predominantly affect the intima and media may cause ischemic strokes, while dissections through the adventitia may lead to formation of pseudoaneurysms or even to subarachnoid hemorrhage, when they spread intracranially. Ischemic strokes can occur due to arterial occlusion by a mural hematoma, or by embolism from thrombi that form on the dissected artery 3 . Despite these relative low incidences, this condition is responsible for up to 10-25% of ischemic strokes in young patients.…”

mentioning

confidence: 99%

Challenges in diagnosis and treatment of cervico-cephalic arterial dissections

Conforto

2016

Arq. Neuro-Psiquiatr.

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I n this number of Arquivos de Neuro-psiquiatria, Fragoso and colleagues reported a series of fourty-one cases of cervical or intracranial arterial dissections. Clinical information was retrospectively collected for dissections considered to have occurred in close temporal association with practice of physical activity, ranging from brisk walks to bungee-jumping. One patient presented an isolated Horner´s syndrome while the other forty subjects presented anterior or posterior circulation infarct syndromes 1 . Exclusively cervical dissections were identified in twenty-nine patients while exclusively intracranial dissections were observed in eight, and combined cervical/intracranial dissections, in four cases.Spontaneous cervical artery dissections have been associated with mechanical triggers including, but not restricted to, minor traumas that can happen in the context of physical activity. It has been hypothesized that an underlying arteriopathy leading to ultrastructural abnormalities and arterial weakness is likely present, increasing susceptibility to dissections in affected subjects 2,3,4 . However, cervical dissections are often diagnosed in the absence of prior mechanical triggers. Case series cannot establish cause-effect relations between possible triggers and dissections. Still, results of an observational study suggested that mechanical triggers may indeed have a role in cervical artery dissections. In this study, Engelter et al.2 systematically evaluated the presence and type of prior cervical trauma in patients with cervical artery dissection (n = 966) as well as in two other groups: age-and sex-matched patients with ischemic strokes with etiologies diferent from cervical artery dissection, (n = 651) and healthy subjects (n = 280). Prior mechanical triggers were more common in patients with cervical artery dissection than in patients with stroke due to other causes (adjusted odds ratio, 7.6 [95%CI 5.6 -10.2]), or in healthy subjects (adjusted odds ratio, 3.7 [95%CI 2.4 -5.6]). Strokes were less common and neck pain was more common in patients with dissections plus history of prior mechanical triggers than in those without. This study only included patients with cervical artery dissections. It still remains to be determined whether mechanical triggers play a role in patients with intracranial artery dissections 4 .

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Spontaneous cervical artery dissection: an update on clinical and diagnostic aspects

Cited by 28 publications

References 62 publications

Spontaneous internal carotid artery rupture during neck dissection in osteogenesis imperfecta patient

Spontaneous internal carotid artery rupture during neck dissection in osteogenesis imperfecta patient

A case of carotid artery dissection devoleped after swimming: The role of heterezygote C677T MTHFR gen mutation

Challenges in diagnosis and treatment of cervico-cephalic arterial dissections

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