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Bax M, Romanov V, Junday K, Giannoulatou E, Martinac B, Kovacic JC, Liu R, Iismaa SE, Graham RM. Arterial dissections: Common features and new perspectives. Front Cardiovasc Med 2022; 9:1055862. [PMID: 36561772 PMCID: PMC9763901 DOI: 10.3389/fcvm.2022.1055862] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Arterial dissections, which involve an abrupt tear in the wall of a major artery resulting in the intramural accumulation of blood, are a family of catastrophic disorders causing major, potentially fatal sequelae. Involving diverse vascular beds, including the aorta or coronary, cervical, pulmonary, and visceral arteries, each type of dissection is devastating in its own way. Traditionally they have been studied in isolation, rather than collectively, owing largely to the distinct clinical consequences of dissections in different anatomical locations - such as stroke, myocardial infarction, and renal failure. Here, we review the shared and unique features of these arteriopathies to provide a better understanding of this family of disorders. Arterial dissections occur commonly in the young to middle-aged, and often in conjunction with hypertension and/or migraine; the latter suggesting they are part of a generalized vasculopathy. Genetic studies as well as cellular and molecular investigations of arterial dissections reveal striking similarities between dissection types, particularly their pathophysiology, which includes the presence or absence of an intimal tear and vasa vasorum dysfunction as a cause of intramural hemorrhage. Pathway perturbations common to all types of dissections include disruption of TGF-β signaling, the extracellular matrix, the cytoskeleton or metabolism, as evidenced by the finding of mutations in critical genes regulating these processes, including LRP1, collagen genes, fibrillin and TGF-β receptors, or their coupled pathways. Perturbances in these connected signaling pathways contribute to phenotype switching in endothelial and vascular smooth muscle cells of the affected artery, in which their physiological quiescent state is lost and replaced by a proliferative activated phenotype. Of interest, dissections in various anatomical locations are associated with distinct sex and age predilections, suggesting involvement of gene and environment interactions in disease pathogenesis. Importantly, these cellular mechanisms are potentially therapeutically targetable. Consideration of arterial dissections as a collective pathology allows insight from the better characterized dissection types, such as that involving the thoracic aorta, to be leveraged to inform the less common forms of dissections, including the potential to apply known therapeutic interventions already clinically available for the former.
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Affiliation(s)
- Monique Bax
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Valentin Romanov
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Keerat Junday
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Boris Martinac
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Jason C. Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- St. Vincent’s Hospital, Darlinghurst, NSW, Australia
- Icahn School of Medicine at Mount Sinai, Cardiovascular Research Institute, New York, NY, United States
| | - Renjing Liu
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia
- UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
- St. Vincent’s Hospital, Darlinghurst, NSW, Australia
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"Crick" in Neck Followed by Massage Led to Stroke: Uncommon Case of Vertebral Artery Dissection. World Neurosurg 2018; 115:41-43. [PMID: 29653277 DOI: 10.1016/j.wneu.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Vertebral artery dissection (VAD) is an important cause of stroke in young and a known complication of spinal manipulation procedures, although dissection following neck massage has rarely been reported in literature. Head and neck massage by improperly trained salon employees is very popular and widely practiced in developing countries like India. In the present report we present a case of VAD following neck massage. MATERIAL AND METHODS We present an unusual case of VAD in a 30-year-old male patient following an episode of neck massage. He developed headache, nausea, vomiting, blurred vision, diplopia, dizziness, and ataxia following the procedure. Initial history and examination suggested that the patient's symptoms were vascular in origin. We also discuss a brief review of the pathology, diagnosis, symptomatology, treatment, prognosis, and occurrence of this rare entity. RESULTS Computed tomography and magnetic resonance imaging of the brain revealed acute infarction of the left cerebellar hemisphere. Digital subtraction angiography showed narrowing and dilatation of the V3 segment of the left vertebral artery with narrowing of the V4 segment consistent with dissection, along with a cavernous segment aneurysm of the contralateral internal carotid artery. CONCLUSION This report illustrates the potential hazards associated with neck massage. The vertebral arteries are at risk for dissection, which can lead to acute stroke. This case also suggests that careful history taking and awareness of the symptoms of VAD are necessary to diagnose this entity as timely diagnosis and treatment can prevent permanent disability or even death.
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Mehdi E, Aralasmak A, Toprak H, Yıldız S, Kurtcan S, Kolukisa M, Asıl T, Alkan A. Craniocervical Dissections: Radiologic Findings, Pitfalls, Mimicking Diseases: A Pictorial Review. Curr Med Imaging 2018; 14:207-222. [PMID: 29853818 PMCID: PMC5902863 DOI: 10.2174/1573405613666170403102235] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background: Craniocervical Dissections (CCD) are a crucial emergency state causing 20% of strokes in patients under the age of 45. Although DSA (digital substraction angiography) is regarded as the gold standard, noninvasive methods of CT, CTA and MRI, MRA are widely used for diagnosis. Aim: Our aim is to illustrate noninvasive imaging findings in CCD. Conclusion: Emphasizing on diagnostic pitfalls, limitations and mimicking diseases.
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Affiliation(s)
- Elnur Mehdi
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Ayse Aralasmak
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Huseyin Toprak
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Seyma Yıldız
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Serpil Kurtcan
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Mehmet Kolukisa
- Bezmialem Vakif University, Department of Neurology, Istanbul, Turkey
| | - Talip Asıl
- Bezmialem Vakif University, Department of Neurology, Istanbul, Turkey
| | - Alpay Alkan
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
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Zhu Z, Xu Y, Wang Y, Zhou Z, Han X, Liu A, Peng J, Xu Y, Wang L. Chinese Cervicocephalic artery dissection study (CCADS): rationale and protocol for a multicenter prospective cohort study. BMC Neurol 2018; 18:6. [PMID: 29325539 PMCID: PMC5765701 DOI: 10.1186/s12883-018-1011-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/03/2018] [Indexed: 11/10/2022] Open
Abstract
Background Cervicocephalic artery dissection (CAD) is an important etiology of stroke in the youth. Findings from recent studies suggest it a “group of disease entities” with different underlying etiologies, presentations and prognosis, necessitating an integral study including various types of CAD to get a better understanding of this disease. In addition, Chinese patients with CAD are likely to carry different features from their western counterparts, which remains uncertain yet. Chinese Cervicocephalic Artery Dissection Study (CCADS) therefore aims at exploring the epidemiology, risk factors, clinical/radiological features, diagnosis and prognosis of CAD in Chinese patients. Methods/design CCADS is a multicenter prospective cohort study enrolling patients age ≥ 18 years with recent (<14 days after onset) CAD. Baseline clinical data, laboratory tests and imaging studies are performed within 3 days after admission, and follow-ups will be conducted through face-to-face interviews at discharge, 3 months, 6 months and 12 months after admission, when the modified Rankin Scale (mRS), cerebrovascular events, medication compliance, CAD evolution and so on are evaluated. Additional blood samples will also be collected at baseline, 3 and 12 months follow-up. The primary outcome is radiographic evolution of CAD; secondary outcomes include cerebrovascular events, major bleeding complications, all-cause mortality and functional independence. Discussion Through the integration of information on epidemiology, risk factors, clinical/radiological features and prognosis of various types of CAD in Chinese population, combined with the application of advanced imaging techniques, collection of potential blood biomarkers, and assessment of novel treatment strategies. CCADS will provide thorough information on CAD - the major cause of stroke in the youth, and play a role in prevention and treatment determination in the future. Electronic supplementary material The online version of this article (10.1186/s12883-018-1011-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zhu Zhu
- Department of Neurology, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyuan Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zhenhua Zhou
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xiang Han
- Department of Neurology, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Aihua Liu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China; Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jing Peng
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yi Xu
- Department of Neurology, State Key Laboratory of Medical Neurobiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Luyao Wang
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
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Song KJ, Choi BW, Lee DH, Lim DJ, Oh SY, Kim SS. Acute airway obstruction due to postoperative retropharyngeal hematoma after anterior cervical fusion: a retrospective analysis. J Orthop Surg Res 2017; 12:19. [PMID: 28126028 PMCID: PMC5270356 DOI: 10.1186/s13018-017-0517-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Acute airway obstruction (AAO) after anterior cervical fusion (ACF) can be caused by postoperative retropharyngeal hematoma, which requires urgent recognition and treatment. However, the causes, evaluation, and appropriate treatment of this complication are not clearly defined. The purpose of this retrospective review of a prospective database was to investigate etiologic factors related to the development of AAO due to postoperative hematoma after ACF and formulate appropriate prevention and treatment guidelines. Methods Cervical spinal cases treated at our academic institutions from 1998 to 2013 were evaluated. Demographic data, including factors related to hemorrhagic tendency, and operative data were analyzed. Patients who developed a hematoma were compared with those who did not to identify risk factors. Cases complicated by hematoma were reviewed, and times until development of hematoma and surgical evacuation were determined. Degrees of airway compromise and patient behavior were classified and evaluated. Treatment was selected according to the patient’s status. Results Among 785 ACF procedures performed, there were nine cases (1.15%) of AAO. None of these nine patients had preoperative risk factors. In six patients (67%), the hematoma occurred within 24 h, whereas three patients (33%) presented with hematoma at a median of 72 h postoperatively. Four of the nine patients with AAO underwent evacuation of the hematoma. Two patients with inspiratory stridor, anterior neck swelling, and facial edema progressed to respiratory distress and their hematomas were removed by surgery, during which, sustained superficial venous bleeding was confirmed. Intubation was attempted several times in one patient with cyanosis, but is unsuccessful; cricothyroidotomy was performed in this patient and pumping in the small muscular arterial branches was confirmed in the operating room. All of the patients recovered without any complications. Conclusions With rapid recognition and appropriate treatment, there were no long-term complications caused by postoperative hematoma. There were no specific preoperative risk factors for hematoma. Systematic evaluation and appropriate management can be helpful for preventing serious complications after development of a postoperative hematoma.
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Affiliation(s)
- Kyung-Jin Song
- Department of Orthopaedic Surgery, Chonbuk National University Medical School, Jeonju, Korea
| | - Byung-Wan Choi
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea
| | - Dong-Hyun Lee
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea
| | - Dong-Ju Lim
- Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Seung-Yeol Oh
- Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sung-Soo Kim
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan, 48108, Korea.
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Yvon C, Adams A, McLauchlan D, Ramsden C. Headache and transient visual loss as the only presenting symptoms of vertebral artery dissection: a case report. J Med Case Rep 2016; 10:105. [PMID: 27113722 PMCID: PMC4843209 DOI: 10.1186/s13256-016-0893-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 04/03/2016] [Indexed: 11/27/2022] Open
Abstract
Background Vertebral artery dissection is an important cause of stroke in the young and diagnosis is often challenging as symptoms are varied and subtle. Case presentation A 33-year-old, previously healthy, white male office worker was stretching his neck when he developed sudden left-sided visual loss lasting 5 minutes associated with headache. He had no other neurological symptoms or signs. He was investigated with a computed tomography angiogram, which revealed a left vertebral artery dissection with a right posterior cerebral artery vascular occlusion. Conclusions We describe an atypical case of vertebral artery dissection presenting with sudden transient visual disturbance without neurological signs in an otherwise healthy man. This is a rare but potentially fatal condition that can result in thromboembolic infarction. A high index of suspicion is crucial to make an early diagnosis and avoid devastating neurological outcomes.
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Affiliation(s)
- Camille Yvon
- Institute of Ophthalmology, University College London, London, UK
| | | | - Duncan McLauchlan
- Department of Radiology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Conor Ramsden
- Institute of Ophthalmology, University College London, London, UK. .,Moorfields Eye Hospital, London, UK.
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Prognosis of spontaneous cervical artery dissection and transcranial Doppler findings associated with clinical outcomes. Eur Radiol 2015; 26:1284-91. [DOI: 10.1007/s00330-015-3944-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/06/2015] [Accepted: 07/23/2015] [Indexed: 11/27/2022]
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Impact of a comprehensive stroke centre on the care of patients with acute ischaemic stroke due to cervical artery dissection. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2014.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Li Q, Tian CL, Yang YW, Lou X, Yu SY. Conventional T2-Weighted Imaging to Detect High-Grade Stenosis and Occlusion of Internal Carotid Artery, Vertebral Artery, and Basilar Artery. J Stroke Cerebrovasc Dis 2015; 24:1591-6. [PMID: 25900410 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/16/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND To evaluate the reliability of conventional T2-weighted imaging (WI) for detecting high-grade stenosis and occlusion of cerebral arteries by disappearance of artery flow void signals. METHODS Our hospital's neuroimaging data on patients with ischemic stroke or transient ischemic attack were collected, including only those from patients who underwent both conventional brain T2WI and three-dimensional time-of flight magnetic resonance angiography (3D-TOF MRA). Flow void signals of conventional axial T2WI were analyzed by 2 young neurologists and compared with 3D-TOF MRA as the gold standard to determine the specificity for detection of high-grade stenosis and occlusion of cerebral arteries. Interobserver agreement was evaluated by calculating kappa (κ) coefficients. RESULTS Of the 1765 patients included, disappearance of flow void signals was detected in 445 major cerebral arteries in 320 patients on conventional axial T2WI. The specificity of disappearance of flow void signal for the diagnosis of high-grade stenosis and occlusion was 94% for internal carotid arteries, 96.2% for vertebral arteries, and 92% for basilar arteries. K coefficients were greater than .94 for all arteries. CONCLUSIONS Disappearance of flow void signal on conventional axial T2WI is a reliable indicator of high-grade stenosis or occlusion of major cerebral arteries. Conventional axial T2WI is a useful tool in the diagnosis of cerebral artery steno-occlusive disease.
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Affiliation(s)
- Qian Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Cheng-Lin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.
| | - Ya-Wen Yang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Sheng-Yuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Minor trauma causing stroke in a young athlete. Case Rep Neurol Med 2015; 2015:182875. [PMID: 25883815 PMCID: PMC4391316 DOI: 10.1155/2015/182875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 11/17/2022] Open
Abstract
A 17-year-old Caucasian male presented with sudden dizziness, ataxia, vertigo, and clumsiness lasting for a couple of hours. He had a subtle trauma during a wrestling match 2 days prior to the presentation. A CT Angiogram (CTA) and MRI showed left vertebral artery dissection (VAD). The patient was treated with anticoagulation with heparin drip in the ICU. The patient was discharged home on the third day on Lovenox-warfarin bridging. This case underscores the importance of considering VAD as a differential diagnosis in patients with sports-related symptoms especially in activities entailing hyperextension or hyperrotation of neck. Due to a varied latent period, often minor underlying trauma, and subtle presentation, a low index of suspicion is warranted in timely diagnosis and treatment of VAD. Considering recent evidence in treatment modality, either antiplatelet therapy or anticoagulation may be used for treatment of VAD.
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Almendrote M, Millán M, Prats LA, Pérez de la Ossa N, López-Cancio E, Gomis M, Dorado L, Hernández-Pérez M, Hidalgo C, García-Bermejo P, Castaño C, Domenech S, Dávalos A. Impact of a comprehensive stroke centre on the care of patients with acute ischaemic stroke due to cervical artery dissection. Neurologia 2014; 30:331-8. [PMID: 24560473 DOI: 10.1016/j.nrl.2014.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 12/25/2013] [Accepted: 01/16/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Cervical artery dissection (CAD) is the cause of 2% to 3% of ischaemic strokes and 10% to 25% of the ischaemic strokes in young people. Our objective is to evaluate whether implementation of a comprehensive stroke centre (CSC) improves the diagnosis and modifies the prognosis of patients with acute stroke due to CAD. PATIENTS AND METHODS Retrospective study of a registry of consecutive patients with acute stroke due to CAD. They were classified according to the period of care at our centre: pre-CSC (October 2004-March 2008, 42 months) or post-CSC (April 2008-June 2012, 51 months). We compared baseline characteristics, methods of diagnosis, treatment and outcome of these patients in both periods. RESULTS Nine patients were diagnosed with CAD in pre-CSC and 26 in post-CSC, representing 0.8% and 2.1% of all ischaemic strokes treated in each period, respectively. The diagnosis of CAD was made within the first 24 hours in 42.3% of the patients in post-CSC versus 0% in pre-CSC, by using urgent cerebral angiography as a diagnostic test in 46.2% of cases in the second period compared to 0% in the first. Both severity of stroke (median NIHSS score 11 vs. 3, P=.014) and time to neurological care (265 min vs 148, P=.056) were higher in the post-CSC period. Endovascular treatment was performed in 34.3%, and all treatments were post-CSC. The functional outcome was comparable for both periods. CONCLUSIONS Implementation of a CSC increases the frequency of the diagnosis of CAD, as well as the treatment options for these patients in the acute phase of stroke.
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Affiliation(s)
- M Almendrote
- Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
| | - M Millán
- Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - L A Prats
- Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - N Pérez de la Ossa
- Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - E López-Cancio
- Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - M Gomis
- Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - L Dorado
- Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - M Hernández-Pérez
- Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - C Hidalgo
- Unidad de Neurorradiología Intervencionista, Departamento de Neurociencias, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - P García-Bermejo
- Unidad de Neurorradiología Intervencionista, Departamento de Neurociencias, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - C Castaño
- Unidad de Neurorradiología Intervencionista, Departamento de Neurociencias, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - S Domenech
- Institut de Diagnòstic per la Imatge, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - A Dávalos
- Unidad de Ictus, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
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Amin FM, Larsen VA, Tfelt-Hansen P. Vertebral artery dissection associated with generalized convulsive seizures: a case report. Case Rep Neurol 2013; 5:125-9. [PMID: 23904852 PMCID: PMC3728598 DOI: 10.1159/000354033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A 46-year-old male with juvenile myoclonic epilepsy was admitted to the neurological department for convulsive seizures just after lamotrigine was discontinued. On admission he was awake but had a right-sided hemiparesis with Babinski sign and ataxic finger-nose test on the left side. An MR scan showed a left-sided pontine infarction, an infarct in the left cerebellar hemisphere and a right vertebral artery dissection (VAD). The patient was treated with heparin and an oral anticoagulant for 6 months. Recovery of neurologic function was excellent. In patients with symptoms of disturbances of posterior circulation after epileptic seizures, VAD should be considered.
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Affiliation(s)
- Faisal Mohammad Amin
- Department of Neurology, Glostrup Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Loret JE, Francois P, Papagiannaki C, Cottier JP, Terrier LM, Zemmoura I. Internal carotid artery dissection after anterior cervical disc replacement: first case report and literature review of vascular complications of the approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23 Suppl 1:S107-10. [PMID: 23728441 DOI: 10.1007/s00590-013-1228-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 04/28/2013] [Indexed: 12/25/2022]
Abstract
We report the case of a 41-year-old woman who underwent cervical total disc replacement at C4C5 and C5C6 levels and fusion at C6C7 level through an anterior right-side approach. After anesthesia recovery, the patient presented left hemiparesia and facial palsy due to large right hemispheric stroke. Diffusion-weighted magnetic resonance imaging was performed as soon as the patient developed neurologic symptoms of stroke and revealed a right internal carotid artery dissection. Digital substraction angiography, endovascular stenting, angioplasty and thrombectomy were performed. Six months after treatment, clinical examination showed mild left-arm spasticity. To the best of our knowledge, only two cases of internal carotid artery stroke without dissection or thrombosis are reported. In conclusion, although vascular complications are rare after anterior cervical spine procedure, internal carotid artery dissection can occur. Suspected risk factors are prolonged retraction of the carotid artery and neck extension.
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Jatuzis D, Valaikiene J. Migraine-like presentation of vertebral artery dissection after cervical manipulative therapy. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.permed.2012.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Fusco MR, Harrigan MR. Cerebrovascular Dissections—A Review Part I: Spontaneous Dissections. Neurosurgery 2011; 68:242-57; discussion 257. [DOI: 10.1227/neu.0b013e3182012323] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
abstract
Spontaneous cerebrovascular dissections are subintimal or subadventitial cervical carotid and vertebral artery wall injuries and are the cause of as many as 2% of all ischemic strokes. Spontaneous dissections are the leading cause of stroke in patients younger than 45 years of age, accounting for almost one fourth of strokes in this population. A history of some degree of trivial trauma is present in nearly one fourth of cases. Subsequent mortality or neurological morbidity is usually the result of distal ischemia produced by emboli released from the injury site, although local mass effect produced by arterial dilation or aneurysm formation also can occur. The gold standard for diagnosis remains digital subtraction angiography. Computed tomography angiography, magnetic resonance angiography, and ultrasonography are complementary means o evaluation, particularly for injury screening or treatment follow-up. The annual rate of stroke after injury is approximately 1% or less per year. The currently accepted method of therapy remains antithrombotic medication, either in the form of anticoagulation or antiplatelet agents; however, no class I medical evidence exists to guide therapy. Other options for treatment include thrombolysis and endovascular therapy, although the efficacy and indications for these methods remain unclear.
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Affiliation(s)
- Matthew R. Fusco
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark R. Harrigan
- Department of Surgery, Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
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Silvestrini M, Altamura C, Cerqua R, Pedone C, Balucani C, Luzzi S, Bartolini M, Provinciali L, Vernieri F. Early Activation of Intracranial Collateral Vessels Influences the Outcome of Spontaneous Internal Carotid Artery Dissection. Stroke 2011; 42:139-43. [DOI: 10.1161/strokeaha.110.595843] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mauro Silvestrini
- From the Department of Neuroscience (M.S., R.C., S.L., M.B., L.P.), Marche Polytechnic University, Ancona; Department of Clinical Neurology (C.A., F.V.), University Campus Bio-Medico, Rome; Department of Geriatric Medicine (C.P.), University Campus Bio-Medico, Rome; and Department of Clinical Neurology (C.B.), University of Perugia, Perugia, Italy
| | - Claudia Altamura
- From the Department of Neuroscience (M.S., R.C., S.L., M.B., L.P.), Marche Polytechnic University, Ancona; Department of Clinical Neurology (C.A., F.V.), University Campus Bio-Medico, Rome; Department of Geriatric Medicine (C.P.), University Campus Bio-Medico, Rome; and Department of Clinical Neurology (C.B.), University of Perugia, Perugia, Italy
| | - Raffaella Cerqua
- From the Department of Neuroscience (M.S., R.C., S.L., M.B., L.P.), Marche Polytechnic University, Ancona; Department of Clinical Neurology (C.A., F.V.), University Campus Bio-Medico, Rome; Department of Geriatric Medicine (C.P.), University Campus Bio-Medico, Rome; and Department of Clinical Neurology (C.B.), University of Perugia, Perugia, Italy
| | - Claudio Pedone
- From the Department of Neuroscience (M.S., R.C., S.L., M.B., L.P.), Marche Polytechnic University, Ancona; Department of Clinical Neurology (C.A., F.V.), University Campus Bio-Medico, Rome; Department of Geriatric Medicine (C.P.), University Campus Bio-Medico, Rome; and Department of Clinical Neurology (C.B.), University of Perugia, Perugia, Italy
| | - Clotilde Balucani
- From the Department of Neuroscience (M.S., R.C., S.L., M.B., L.P.), Marche Polytechnic University, Ancona; Department of Clinical Neurology (C.A., F.V.), University Campus Bio-Medico, Rome; Department of Geriatric Medicine (C.P.), University Campus Bio-Medico, Rome; and Department of Clinical Neurology (C.B.), University of Perugia, Perugia, Italy
| | - Simona Luzzi
- From the Department of Neuroscience (M.S., R.C., S.L., M.B., L.P.), Marche Polytechnic University, Ancona; Department of Clinical Neurology (C.A., F.V.), University Campus Bio-Medico, Rome; Department of Geriatric Medicine (C.P.), University Campus Bio-Medico, Rome; and Department of Clinical Neurology (C.B.), University of Perugia, Perugia, Italy
| | - Marco Bartolini
- From the Department of Neuroscience (M.S., R.C., S.L., M.B., L.P.), Marche Polytechnic University, Ancona; Department of Clinical Neurology (C.A., F.V.), University Campus Bio-Medico, Rome; Department of Geriatric Medicine (C.P.), University Campus Bio-Medico, Rome; and Department of Clinical Neurology (C.B.), University of Perugia, Perugia, Italy
| | - Leandro Provinciali
- From the Department of Neuroscience (M.S., R.C., S.L., M.B., L.P.), Marche Polytechnic University, Ancona; Department of Clinical Neurology (C.A., F.V.), University Campus Bio-Medico, Rome; Department of Geriatric Medicine (C.P.), University Campus Bio-Medico, Rome; and Department of Clinical Neurology (C.B.), University of Perugia, Perugia, Italy
| | - Fabrizio Vernieri
- From the Department of Neuroscience (M.S., R.C., S.L., M.B., L.P.), Marche Polytechnic University, Ancona; Department of Clinical Neurology (C.A., F.V.), University Campus Bio-Medico, Rome; Department of Geriatric Medicine (C.P.), University Campus Bio-Medico, Rome; and Department of Clinical Neurology (C.B.), University of Perugia, Perugia, Italy
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Life-threatening late hemorrhage due to superior thyroid artery dissection after anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 2010; 35:E739-42. [PMID: 20535048 DOI: 10.1097/brs.0b013e3181cf46b4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE The object of this report is to identify causes of late bleeding after anterior cervical discectomy and to suggest an optimal management plan. SUMMARY OF BACKGROUND DATA The anterior discectomy and fusion is one of the most common spine procedures for cervical disc disease. Although this procedure has a low postoperative morbidity rate, rarely fatal vascular complications occur, the majority of which can be predicted intraoperatively. However, causes of unpredicted delayed bleeding are not fully understood. METHODS We reviewed the hospital charts and radiographs of a patient who underwent coil embolization for late bleeding after anterior cervical discectomy with fusion (ACDF). RESULTS A 33-year-old man underwent ACDF for cervical discs at C3-C4 and C4-C5. Intraoperatively, there was no major bleeding and the operation was completed after meticulous hemostasis. The patient was discharged 6 days after surgery without complications. However, at 16 days after surgery, the patient revisited the emergency room with sudden progressive neck swelling and accompanying respiratory difficulty. Because the neck swelling was rapidly progressing, the wound was opened in the intensive care unit under local anesthesia due to suspicion of hematoma. After evacuating the hematoma, we encountered active bleeding, which was controlled with gauze packing, but we were unable to identify the bleeding focus. After intubation, emergency right common carotid angiography was performed. Dissection of the right superior thyroid artery with active bleeding was identified, and this was promptly embolized with coils. After angiographic intervention, the remnant hematoma was removed in an operating room. The patient was discharged 5 days later without complication. CONCLUSION This is the first report that shows late hemorrhage due to superior thyroid artery dissection after ACDF. This case cautions that intraoperative injury to an artery, unrecognized at operation, may cause late hemorrhage.
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Bouzat P, Francony G, Brun J, Lavagne P, Picard J, Broux C, Declety P, Jacquot C, Albaladejo P, Payen JF. Detecting traumatic internal carotid artery dissection using transcranial Doppler in head-injured patients. Intensive Care Med 2010; 36:1514-20. [PMID: 20490780 DOI: 10.1007/s00134-010-1919-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 04/07/2010] [Indexed: 12/11/2022]
Abstract
PURPOSE The early diagnosis of traumatic internal carotid artery dissection (TICAD) is essential for initiating appropriate treatment and improving outcome. We searched for criteria from transcranial Doppler (TCD) measurements on admission that could be associated with subsequent TICAD diagnosis in patients with traumatic brain injury (TBI). METHODS We conducted a retrospective 1:4 matched (age, mean arterial blood pressure) cohort study of 11 TBI patients with TICAD and absent or mild brain lesions on initial CT scan, 22 TBI controls with comparable brain CT scan lesions (controls 1), and 22 TBI controls with more severe brain CT scan lesions (controls 2) on admission. TCD measurements were obtained on admission from both middle cerebral arteries (MCA). All patients had subsequent CT angiography to diagnose TICAD. RESULTS A >25% asymmetry in the systolic blood flow velocity between the two MCA was found in 9/11 patients with TICAD versus 0/22 in controls 1 and 5/22 in controls 2 (p < 0.01). The combination of this asymmetry with an ipsilateral pulsatility index < or =0.80 was found in 9/11 patients with TICAD versus none in the two groups of controls (p < 0.01). CONCLUSIONS Our results suggest that significant asymmetry in the systolic blood flow velocity between the MCAs and a reduced ipsilateral pulsatility index could be criteria from TCD measurements associated with the occurrence of TICAD in head-injured patients. If prospectively validated, these findings could be incorporated in screening protocols for TICAD in patients with TBI.
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Affiliation(s)
- Pierre Bouzat
- Department of Anesthesiology and Critical Care, Albert Michallon Hospital, 38000, Grenoble, France
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Traumatic vertebral artery dissection presenting with incomplete congruous homonymous quadrantanopia. BMC Ophthalmol 2010; 10:14. [PMID: 20482837 PMCID: PMC2885997 DOI: 10.1186/1471-2415-10-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 05/19/2010] [Indexed: 11/17/2022] Open
Abstract
Background To describe a rare presentation of vertebral artery dissection (VAD) as a small but congruous incomplete homonymous hemianopia demonstrating use of visual field testing in the diagnosis. Case presentation A 30 year old woman had been unwell for 4 months with difficulty focusing, vertigo, dizziness and a feeling of falling to the right. A small but congruous right inferior homonymous quadrantanopia was found on examination leading to further investigation that uncovered a vertebral artery dissection and multiple posterior circulation infarctions including a left occipital stroke matching the field defect. Conclusions We describe an atypical case of VAD presenting with a small congruous quadrantanopia. This is a rare but significant condition that predisposes to multiple thromboembolic infarction that may be easily misdiagnosed and a high index of suspicion is required to make the diagnosis.
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[Cerebrovascular diseases]. Internist (Berl) 2009; 50:945-51. [PMID: 19562263 DOI: 10.1007/s00108-009-2367-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the majority of the cases cerebrovascular disease is caused by atherosclerosis. Duplexsonography is the diagnostic tool of first choice. Management of cardiovascular risk factors is of paramount importance in secondary prevention of atherosclerotic vascular complications. Patients with a symptomatic internal carotid artery stenosis >70% have a clear indication for revascularization. Asymptomatic patients with >60% stenosis benefit from revascularisation if the perioperative risk for death or stroke is below 3%. The optimal revascularization strategy highly depends on the expertise of the local surgeon or endovascular specialist. In younger patients with cerebrovascular disease rare causes such as dissection, large vessel arteritis, fibromuscular dysplasia or vasospasms have to be considered.
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