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Metanis I, Simaan N, Schwartzmann Y, Jubeh T, Honig A, Jubran H, Magadle J, Cohen JE, Leker RR. Are There Differences between Traumatic and Spontaneous Cervical Artery Dissections? J Clin Med 2024; 13:4443. [PMID: 39124708 PMCID: PMC11312695 DOI: 10.3390/jcm13154443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
(1) Background: Cervical arterial dissections (CeAD) are a common cause of stroke in young adults. CeAD can be spontaneous (sCeAD) or traumatic (tCeAD). Whether CeAD subtypes differ in clinical, radiological, and outcome characteristics remains unexplored. (2) Methods: Patients with CeAD were identified and divided between sCeAD and tCeAD. Demographics, clinical features, risk factors, imaging findings, treatments, and outcomes were compared between the groups. Logistic regressions were used to determine characteristics associated with favorable outcome. (3) Results: Overall, 154 patients were included (106 sCeAD and 48 tCeAD). Patients with sCeAD were significantly older (mean ± SD 46 ± 12 vs. 35 ± 14, p < 0.001) and were more likely to have hyperlipidemia (19% vs. 4%, p = 0.016), but other risk factors did not differ. Patients with tCeAD less often had signs of early infarction on imaging (21% vs. 49%, p = 0.001) and had lower stroke severity on admission (NIHSS, median, interquartile range [IQR] 0 (0-9) vs. 2 (0-4), p = 0.012), but more often had symptomatic intracranial hemorrhages (12.5% vs. 2%, p = 0.006). Patients with tCeAD less often had favorable outcomes at 90 days (78% vs. 97%, p < 0.001). In the regression analysis, the only variables associated with favorable outcome were age (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.03-1.24), initial stroke severity (OR 0.84, 95% CI 0.73-0.97), degree of vessel stenosis (OR 0.35, 95% CI 0.14-0.83), and involvement of multiple vessels on presentation (OR 0.04, 95% CI 0.02-0.70), whereas dissection subtype was not associated (OR 0.45, 95% CI 0.03-68.80). (4) Conclusions: Dissection subtype is not an independent modifier of the chances of attaining functional independence.
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Affiliation(s)
- Issa Metanis
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (I.M.); (N.S.); (Y.S.); (T.J.); (A.H.); (H.J.); (J.M.)
| | - Naaem Simaan
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (I.M.); (N.S.); (Y.S.); (T.J.); (A.H.); (H.J.); (J.M.)
- Department of Neurology, Ziv Medical Center, Safed 1311001, Israel
| | - Yoel Schwartzmann
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (I.M.); (N.S.); (Y.S.); (T.J.); (A.H.); (H.J.); (J.M.)
| | - Tamer Jubeh
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (I.M.); (N.S.); (Y.S.); (T.J.); (A.H.); (H.J.); (J.M.)
| | - Asaf Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (I.M.); (N.S.); (Y.S.); (T.J.); (A.H.); (H.J.); (J.M.)
| | - Hamza Jubran
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (I.M.); (N.S.); (Y.S.); (T.J.); (A.H.); (H.J.); (J.M.)
| | - Jad Magadle
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (I.M.); (N.S.); (Y.S.); (T.J.); (A.H.); (H.J.); (J.M.)
| | - Jose E. Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel;
| | - Ronen R. Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel; (I.M.); (N.S.); (Y.S.); (T.J.); (A.H.); (H.J.); (J.M.)
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Zheng B, Luo X, Zhou J, Huang X, Li M, Zheng H, Yuan Y, Wang J. Case report: Acute ischemic stroke caused by intracranial artery dissection in a patient with skull fractures. Front Neurol 2022; 13:963396. [DOI: 10.3389/fneur.2022.963396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
The intracranial artery dissection (IAD) is an uncommon but life-threatening disease. The IAD would develop a significant cerebral infarction due to unrecognized contrecoup brain injury. We report a 53-year-old man fell to develop blunt cerebrovascular injuries (BCVIs) more than 2 months ago. During his rehabilitation, he often had a transient left headache and underwent short-term right limb weakness twice, but he did not care. He was hospitalized again because of suffering right limb weakness for more than 4 h. The brain computed tomography angiography (CTA) showed subtotal occlusion of the left middle cerebral artery M1 segment, and the vascular morphology displayed the IAD. The patient was then treated with balloon dilation and a self-expanding stent. This case highlights that IAD may show delayed onset with no initial typical symptom. By early detecting of abnormal signs and symptoms, serious traumatic brain injury may be avoided.
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