Spontaneous Multiple Cervical Artery Dissection in the Puerperium

Pires, Christine; Geraldes, Ruth; Neto, Laurentino Biccas; Melo, Teresa Pinho e

doi:10.1159/000332089

Cited by 7 publications

(11 citation statements)

References 9 publications

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“…In conclusion and in agreement with Pires et al [1], we hypothesize that a transient cervical artery vasculopathy may have led to the patient's four-vessel CAD. In our case, this impression is supported by the inadequate immune response resulting in the development of the HELLP syndrome.…”

Section: Discussionsupporting

confidence: 93%

“…Pires et al [1] have recently published a case report of a 31-year-old woman who developed four-vessel cervical artery dissection (CAD) without stroke 18 days after an uncomplicated caesarean delivery. As no mechanical trigger event or prolonged vaginal labour was observed, this case emphasizes the possible vasculotropic origin of this disorder, as suggested by some authors [2].…”

Section: Introductionmentioning

confidence: 99%

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Postpartum Four-Vessel Cervical Artery Dissection

Barroso¹,

Demasles²

2013

Cerebrovasc Dis Extra

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Postpartum Four-Vessel Cervical Artery Dissection

Barroso¹,

Demasles²

2013

Cerebrovasc Dis Extra

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“…A combination of an underlying arteriopathy and a more or less trivial precipitating event is likely the mechanism of CAD [2,3,4,5]. The superiority of anticoagulation (AC) over antiplatelet (AP) agents is a still debated issue [6].…”

Section: Introductionmentioning

confidence: 99%

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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“…As most of the patients in this study were women within child-bearing age range, this association may be coincidental. Other explanatory theories include mechanical pressure on vessel walls associated with protracted delivery, hyperextension of the neck during (general) anesthesia or hemodynamic and hormonal changes related to pregnancy and postpartum that may lead to transient vulnerability of the vessel walls [10].…”

Section: Discussionmentioning

confidence: 99%

Triple and quadruple cervical artery dissections: a systematic review of individual patient data

et al. 2019

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Background and purpose Simultaneous dissection of three or four cervical arteries rarely occurs. As a result, limited information is available on clinical characteristics, underlying causes, treatment, and outcome of these patients. Methods We performed a systematic review of individual patient data on triple and quadruple cervical artery dissection (CeAD). We included all cases for whom, at minimum, data on age, sex and affected cervical arteries were available. Results Out of 1396 publications identified in the initial search, 52 were included, with data available on 96 patients. Mean age was 42 years and 66% were women. 63% had triple CeAD. The most common manifestations were headache (69%), neck pain (44%), motor deficit (36%), and Horner syndrome (34%). 57% had an ischemic stroke, in the majority of these patients the stroke was confined to the vascular territory of a single artery. 83% were managed medically (antiplatelets or anticoagulants) and 11% underwent endovascular treatment. An underlying disease or triggering event was identified in 71%, most commonly trauma (35%, cervical manipulative therapy in 13%), infection (18%), fibromuscular dysplasia (16%), and hereditary connective tissue disorder (8%). In-hospital mortality was 1%. 80% of patients had a good functional outcome (mRS 0–1) at follow-up. Two recurrences (3%) were reported. Conclusions Triple or quadruple CeAD mostly affected young women, and underlying disease or triggering event could be identified in more than two-thirds of patients. Less than two-thirds of triple or quadruple CeAD patients suffered ischemic stroke. Most patients were managed medically and the majority had a favorable outcome. Electronic supplementary material The online version of this article (10.1007/s00415-019-09269-1) contains supplementary material, which is available to authorized users.

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Spontaneous Multiple Cervical Artery Dissection in the Puerperium

Cited by 7 publications

References 9 publications

Postpartum Four-Vessel Cervical Artery Dissection

Postpartum Four-Vessel Cervical Artery Dissection

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

Triple and quadruple cervical artery dissections: a systematic review of individual patient data

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