Vertebral and carotid artery dissection: Difference between revisions
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==Background== | ==Background== | ||
*Most frequent cause of CVA in young and middle-aged patients ( | *Most frequent cause of CVA in young and middle-aged patients (Median age, 40yrs) | ||
*Dissections can occur in both anterior and posterior arterial systems | *Dissections can occur in both anterior and posterior arterial systems | ||
*Symptoms may be transient or persistent | *Symptoms may be transient or persistent | ||
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**Unilateral HA (50-67%), face pain (10%), and/or neck pain (25%) | **Unilateral HA (50-67%), face pain (10%), and/or neck pain (25%) | ||
***Pain can precede other symptoms by hours-days (median 4d) | ***Pain can precede other symptoms by hours-days (median 4d) | ||
***HA most commonly is frontotemporal | ***HA most commonly is frontotemporal; severity may mimic SAH or preexisting migraine | ||
**Partial Horner syndrome (miosis and ptosis) | **Partial Horner syndrome (miosis and ptosis) | ||
**CN palsies | **CN palsies | ||
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==Treatment== | ==Treatment== | ||
#Anticoagulation | #Anticoagulation (after excluding SAH) | ||
==Source== | ==Source== | ||
Revision as of 05:03, 1 October 2011
Background
- Most frequent cause of CVA in young and middle-aged patients (Median age, 40yrs)
- Dissections can occur in both anterior and posterior arterial systems
- Symptoms may be transient or persistent
- Pathophysiology
- Hematoma, platelet aggregation and thrombus formation compromise vessel patency
Risk Factors
- Neck trauma
- Coughing
- Connective tissue disease
- History of migraine
Clinical Features
- Internal Carotid Dissection
- Unilateral HA (50-67%), face pain (10%), and/or neck pain (25%)
- Pain can precede other symptoms by hours-days (median 4d)
- HA most commonly is frontotemporal; severity may mimic SAH or preexisting migraine
- Partial Horner syndrome (miosis and ptosis)
- CN palsies
- Unilateral HA (50-67%), face pain (10%), and/or neck pain (25%)
- Vertebral Artery Dissection
- Posterior neck pain (46%), HA (69%)
- May be unilateral or bilateral
- HA is typically occipital
- Unilateral facial paresthesia
- Dizziness
- Vertigo
- N/V
- Diplopia and other visual disturbances
- Ataxia
- Posterior neck pain (46%), HA (69%)
Diagnosis
- MRI/MRA or CT/CTA
Treatment
- Anticoagulation (after excluding SAH)
Source
- Tintinalli