Vertebral Artery Dissection: Warning Symptoms, Clinical Features and Prognosis in 26 Patients

Abstract

The incidence of cervical artery dissection is unknown. In some series of young patients with stroke, dissection accounts for one fifth to one tenth of cases. 1 Internal carotid artery dissections are widely-known and as a diagnosis are more often sought. 2,3 Although there has been a recent increase in the ABSTRACT: Background and objectives: Internal carotid artery dissection has been extensively studied and well-described. Although there has been a recent increase in the number of reported cases of vertebral artery (VA) dissection, the clinical variety of presentation and the early warning symptoms have not been well-described before. Our objectives in this study include: (1) To determine the early symptoms and warning signs which may help the clinician in the early identification and treatment of patients with VA dissection. (2) To explore the variety of clinical presentation of VA dissection and its relation to prognosis. Design and setting: Retrospective analysis of hospital records in a tertiary academic centre for the period 1989-1999. Results: Twenty-six patients were identified (13 men and 13 women). The mean age was 48. Possible precipitating factors were identified in 14 patients (53%). Sporting activity and chiropractic manipulations were the most common (15% and 11% respectively). Headache and/or neck pain was the prominent feature in 88% of patients and was a warning sign in 53%, preceding onset of stroke by up to 14 days.

Manual therapy and cervical artery dysfunction: Identification of potential risk factors in clinical encounters

“…2,30,31 Symptoms of neck pain or headache associated with a dissecting cervical artery are thought to be due to the tunica adventitia of vessels being innervated with nociceptors. 32 Schelfaut et al 33 Schievink, 30 and Biller et al 9 suggest that these patients often present with at least two symptoms: typically unilateral head, neck or facial pain, and less frequently Horner's syndrome * (accounting for approximately 50% of patients with ICADs). Headaches experienced by the patient are typically unilateral and in the frontotemporal region, although they can present in the occipital region.…”

Diagnosis and treatment of cervikal arteries dissection

“…Doğru yaklaşım ve etkin tedavi seçeneklerinin kullanılması ile vakaların % 90'ında olumlu sonuç alınması mümkündür (6).…”

Evaluation and Management of Acute Cervical Spine Trauma

“…When present, typical clinical findings are vertigo, unilateral facial paresthesia, cerebellar signs, lateral medullary signs, and visual field defects. 18 The clinical significance of dissection is the predisposition to thrombus formation, leading to basilar stroke. Cothren and colleagues 19 note a consistent 20% stroke rate in untreated patients.…”