Traumatic and spontaneous carotid and vertebral artery dissection in a level 1 trauma center

Lleva, Paul; Ahluwalia, Brij Singh; Marks, S.E.; Sahni, Ramandeep; Tenner, Michael; Risucci, Donald A.; Lai, Hoang M.; Li, J.

doi:10.1016/j.jocn.2011.11.018

Cited by 38 publications

(33 citation statements)

References 10 publications

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“…Both the V1 and the V2 segments are reported as being involved or acting as the origins of dissection [10,16,17]. This is in accordance with the findings of the present study, where all segments in the extracranial vertebral arteries had findings defined as dissections.…”

Section: Discussionsupporting

confidence: 92%

Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

Bentsen¹,

Nygård

Ovesen³

et al. 2014

Cerebrovasc Dis Extra

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Introduction: Vascular pathology in the extracranial vertebral arteries remains among the possible causes in cryptogenic stroke. However, the diagnosis is challenged by the great variety in the anatomy of the vertebral arteries, clinical symptoms and difficulties in the radiological assessments. The aim of this study was to assess the prevalence of CT angiography (CTA)-detected pathological findings in the extracranial vertebral arteries in an acute stroke population and secondly to determine the frequency of posterior pathology as probable cause in patients with otherwise cryptogenic stroke. Method: The analysis was based on 657 consecutive patients with symptoms of acute stroke and a final diagnosis of ischemic stroke or transient ischemic attack. On admission, a noncontrast CT cerebrum and CTA were performed. A senior consultant neuroradiologist, blinded to clinical data, reviewed all CTA scans systematically, assessing the four segments of the extracranial vertebral arteries. First, the frequency of pathological findings including stenosis, plaques, dissection, kinked artery and coiling was assessed. Subsequently, we explored the extent of the pathological findings that were the most plausible causes of stroke, namely either a possible dissection or a kinked artery. Results: Findings in the extracranial vertebral arteries included significant stenosis (0.8%), atherosclerotic plaque types (3.8%), possible dissections (2.6%), kinked arteries (2.6%) and coiling (32.0%). Eighteen patients (2.8%) with pathological findings had an unknown cause of stroke, likely posterior symptoms and no clinical stroke symptoms from the anterior circuit. Of these, 3 cases were kinked arteries (0.5%) and 15 cases (2.3%) were possible dissections. Conclusion: We found that in approximately 3% of the study population, the most plausible cause of the cryptogenic strokes was due to a pathological finding in the posterior extracranial vertebral arteries, being either a possible dissection or a kinked artery. In general, posterior vascular pathology is not uncommon, and CTA is a useful modality in the detection of changes based on characteristics and locations of findings in the extracranial vertebral arteries. Ultrasound examination can be a useful supplementary tool in deciding the consequence of vascular findings on CTA.

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Section: Discussionsupporting

confidence: 92%

Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

Bentsen¹,

Nygård

Ovesen³

et al. 2014

Cerebrovasc Dis Extra

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“…Previous studies reported a male predominance of VAD and others a nearly equal distribution with a probably higher incidence of traumatic VAD in men [2,8,9] . We noticed a strong male predominance of 70%, both in the spontaneous (70%) and the traumatic (71%) VAD groups.…”

Section: Demographics Clinical and Laboratory Findingsmentioning

confidence: 82%

Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Günther¹,

Witte²,

Freesmeyer³

et al. 2016

Eur Neurol

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Background/Aims: Vertebral artery dissection (VAD) is an important cause of ischemic stroke. In this observational study, clinical data, magnetic resonance (MR) and ultrasound (US) imaging findings and ischemic patterns were analyzed. Methods: Forty-seven patients with a diagnosis of VAD underwent clinical examination, US, MR of the brain and neck and MR angiography (MRA) of the cervical arteries. Vascular abnormalities and ischemic brain lesions were noted. Data were evaluated separately and compared for spontaneous and traumatic VAD subgroups. Results: The most common overall clinical symptom was vertigo followed by neck pain. In the traumatic subgroup, vertigo was relatively rare (p = 0.022). Most common MRA findings were vessel irregularity and vessel occlusions. Ischemic lesions occurred significantly more frequently after spontaneous than after traumatic VAD (p = 0.009). Unilateral VAD was significantly more common in non-dominant vertebral arteries (p < 0.001). Mortality after trauma was not only due to VAD complications but also due to other trauma-related injuries. Conclusion: The variability of MR and US imaging findings in patients with VAD is illustrated. The algorithm of management should be based on a multimodality approach involving patient history and clinical neurological examination. Several types of vessel abnormalities and ischemic lesion in diverse locations may point to arterial dissection, and the differential diagnosis of VAD must be kept in mind.

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“…4 The intimal disruption and low flow states that arise in VAD create a thrombogenic milieu in which emboli may form and propagate distally resulting in transient ischemia or infarction. 4 If the VAD ruptures through the adventitia, it may cause sub-arachnoid haemorrhage. On imaging, VAD may present as abnormal wall thickening, aneurysmal dilatation, an intimal flap or occlusion.…”

Section: Discussionmentioning

confidence: 99%

Dissection of a Limb of a Vertebral Artery Fenestration: Case Report

Nicola

Lum

Meulemeester

2015

Can. J. Neurol. Sci.

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Can J Neurol Sci. 2016; 43: 329-331 Fenestrations of vertebral and basilar arteries are considered to be rare, congenital malformations observed in angiographic and autopsy studies. They are vascular abnormalities having two different lumens and endothelium layers, sharing either the same or separate adventitia layers. Basilar artery fenestration is an uncommon developmental anomaly occurring in 1% to 5% of autopsy specimens, 1 Vertebrobasilar junction fenestration is considered to be a subtype of fenestration of the proximal basilar artery. Association of a saccular cerebral aneurysm at the fenestration has been well documented. However, dissection of a limb of the vertebral artery fenestration is extremely rare. We describe a case of dissection of the left limb of a left vertebral artery fenestration that initially presented itself as a suspected vertebrobasilar aneurysm. CASE REPORTA 55-year-old man awoke suddenly from sleep with a sudden onset, severe headache behind the left eye lasting approximately ten minutes. The headache was associated with ataxia, diaphoresis, and vomiting. He also recalls an unusual symptom of dysphagia, which lasted approximately ten minutes. All symptoms resolved spontaneously within 15 minutes. He recalls having a similar headache one year ago, which resolved spontaneously. The patient is a single, marine engineer, with a history of hypertension that was managed with olmesartan at the time. He does not drink or smoke and has no significant personal or family history of cardiac or cerebrovascular disease.By the time the patient arrived at the local emergency room, he was asymptomatic. He was evaluated for a possible cardiac cause and was discharged that evening without further investigations secondary to unremarkable findings. After investigating his symptoms on the Internet and becoming concerned he had a cerebral aneurysm, the patient presented to the emergency department at our institution three days later. A lumbar puncture (LP) showed acellular cerebrospinal fluid (CSF) without xanthochromia and a computed tomography (CT) scan of the head without contrast was normal.At this stage, it was appropriate to identify the cause for the patient's dysphagia, which was presumably due to transient ischemia to the lateral medulla (nuclei of cranial nerves IX and X). Thus, the differential diagnosis of a thunderclap headache with associated ataxia, vomiting and dysphagia would include the following:• aneurysm-related subarachnoid hemorrhage (SAH), with vasospasm resulting in focal cerebral ischemia;• reversible cerebral vasoconstriction syndrome (RCVS), with or without associated SAH and focal cerebral ischemia;• artery dissection with focal cerebral ischemia;• occlusive atherosclerotic thromboembolism with focal cerebral ischemia and;• migraine with brainstem aura.Although migraine with brainstem aura can present suddenly and be associated with focal neurological signs and symptoms, dysphagia would be an unusual symptom in relative isolation. Given a negative LP and a CT scan that was...

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Traumatic and spontaneous carotid and vertebral artery dissection in a level 1 trauma center

Cited by 38 publications

References 10 publications

Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

Vascular Pathology in the Extracranial Vertebral Arteries in Patients with Acute Ischemic Stroke

Clinical Presentation, Magnetic Resonance Angiography, Ultrasound Findings, and Stroke Patterns in Patients with Vertebral Artery Dissection

Dissection of a Limb of a Vertebral Artery Fenestration: Case Report

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