107 - Spontaneous Dissections of Cervicocephalic Arteries

Abstract

This chapter describes spontaneous dissections of cervicocephalic arteries. Of the cervicocephalic arteries, the artery that is most commonly involved by dissection is the extracranial segment of the internal carotid artery (ICA). The vertebral artery (VA) is the second most commonly involved vessel. Extracranial VA dissections may extend intracranially, or the dissection may involve only the intracranial segment of the artery, very rarely extending to the basilar artery. Dissections of the ICA are more common in redundant arteries, and hypertension is more common than general population in patients with spontaneous ICA and VA dissections. Basilar artery dissection may occur as an extension of dissection from a vertebral artery, or the dissection may involve only the basilar artery. Clinical manifestations are focal ischemic symptoms in the distribution of posterior circulation, frequently associated with or preceded by occipital headaches or neck pain or both. Spontaneous dissections of middle cerebral arteries, posterior cerebral arteries, and anterior cerebral arteries may rarely occur. Dissections of anterior, middle, or posterior cerebral arteries on angiography may appear as elongated stenoses with or without aneurysmal dilations.