Vertebral and carotid artery dissection

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

1. Neck trauma
2. Coughing
3. Connective tissue disease
4. 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
• 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

Diagnosis

1. MRI/MRA or CT/CTA

Treatment

1. Anticoagulation (after excluding SAH)

Source

• Tintinalli