Spontaneous Intracranial Internal Carotid Artery Dissection

Chaves, Claudia; Estol, Conrado J.; Esnaola, María Martha; Gorson, Kenneth C.; O’Donoghue, Margaret; Witt, L. Dana de; Caplan, Louis R.

doi:10.1001/archneur.59.6.977

Cited by 128 publications

(83 citation statements)

References 30 publications

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“…6,28,43 It has also been reported that intracranial and extracranial dissection can have different clinical presentations. Intracranial dissection can predispose to subarachnoid hemorrhage, 8,21,44 and patients with extracranial dissection most commonly present with ischemic signs and symptoms. Spontaneous CADs are more commonly intracranial, whereas traumatic ones are more commonly extracranial.…”

Section: Discussionmentioning

confidence: 99%

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Chamoun

Mawad

Whitehead

et al. 2008

PED

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Object Currently, no diagnostic or treatment standards exist for extracranial carotid artery dissection (CAD) in children after trauma. The purpose of this study was to review and describe the characteristics, diagnosis, and treatment of this rather uncommon sequelae of pediatric trauma. Methods A systematic review of the literature was performed to examine the pertinent studies of traumatic extracranial carotid artery (CA) injuries in children. Results No randomized trials were identified; however, 19 case reports or small case series consisting of 34 pediatric patients were found in the literature. The diagnosis of CAD was made in 33 of 34 patients only after the onset of ischemic symptomatology. Twenty-four of 34 patients underwent cerebral angiography to confirm diagnosis; MR angiography affirmed the diagnosis in 6 of 34 patients. There was little published experience with CA ultrasonography or CT angiography for diagnosis. Thirty of 34 patients were treated with medical therapy or observation; 2 of 4 patients treated with observation alone died. There was little experience with open surgical treatment of CAD in the pediatric population, and there were no studies on the endovascular treatment of traumatic CAD in children. The literature does not support anticoagulation therapy over antiplatelet therapy. Conclusions As a result of this review of the literature, the authors propose the algorithms for the evaluation and treatment of traumatic extracranial CADs in children. These recommendations include utilizing MR angiography as a screening tool in cases in which the clinical suspicion of CAD is high, using conventional cerebral angiography to confirm the diagnosis, implementing antiplatelet therapy as initial medical management, and reserving endovascular stenting in cases of failed medical treatment.

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Section: Discussionmentioning

confidence: 99%

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Chamoun

Mawad

Whitehead

et al. 2008

PED

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“…Spontaneous MCAD causing ischemic stroke is seldom reported. To our knowledge, there have been fewer than 20 cases, and these are often associated with internal carotid arterial dissection or trauma [1][2][3]. MCAD might be underdiagnosed; in our stroke database, of 940 patients with cerebral infarcts within the MCA distribution on diffusionweighted images, two patients (0.21%) were diagnosed as having MCAD.…”

Section: Discussionmentioning

confidence: 91%

“…Cervicocephalic arterial dissections usually involve the internal carotid and vertebral arteries, especially the extracranial portions. Middle cerebral arterial dissection (MCAD) is rare [1][2][3], and isolated spontaneous cases of MCAD are even seldom reported [2]. The clinical and radiological aspects of MCAD are poorly understood.…”

Section: Introductionmentioning

confidence: 99%

Two cases of spontaneous middle cerebral arterial dissection causing ischemic stroke

Lee

Bang

Lee

et al. 2006

Journal of the Neurological Sciences

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“…Extra-cranial dissections tend to be more common. This has been attributed to the increased mobility of the extra-cranial segments, which are also vulnerable to injury from bony elements such as the vertebrae or styloid processes [8] . Vertebral artery dissection most commonly affects the V3 or V1 segments at the C1 to C2 level [9] .…”

Section: Case Reportmentioning

confidence: 99%

Symptomatic bilateral extra-cranial vertebral artery dissections induced by sexual activity

Michael

Calvin

Christopher

et al. 2016

IJDI

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Introduction: Trauma is a well-recognized cause of vertebral artery dissection (VAD) and even minor episodes of trauma, including sneezing and vigorous exercise, have been implicated. Symptomatic bilateral vertebral artery dissections after sexual activity to our knowledge has not been reported. Case report:A 32-year-old female presented with a three week history of occipito-cervical headaches. Noninvasive imaging identified bilateral vertebral artery dissections. The etiology was inferred after a directed clinical history revealed sexual activity characterized by aggressive repeated neck hyperextension from hair-pulling during intercourse. Conclusion:We report a case of symptomatic bilateral VAD in the setting sexual intercourse related trauma. The quality of clinical data gathering, in particular pertinent history taking is imperative in determining a potential cause. This is important in patient counselling so as to prevent recurrence.

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Spontaneous Intracranial Internal Carotid Artery Dissection

Abstract: Spontaneous intracranial ICA dissection can cause ischemic stroke with or without subarachnoid hemorrhage and should be considered in the differential diagnosis of intracranial ICA stenosis or occlusion, especially in young patients. Some patients survive with few or moderate deficits.

Cited by 128 publications

References 30 publications

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Two cases of spontaneous middle cerebral arterial dissection causing ischemic stroke

Symptomatic bilateral extra-cranial vertebral artery dissections induced by sexual activity

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