Cervical and intracranial arterial dissection: review of the acute clinical presentation and imaging of 48 cases

Abstract

Arterial dissections result from longitudinal tear of the vessel wall produced by an intramural haematoma. We have retrospectively review 48 consecutive patients with 53 arterial dissections diagnosed by cerebral angiography and/or magnetic resonance imaging. Arterial dissections were extracranial in 88% (carotid in 58% and vertebral in 30%) and intracranial in 12% of cases, with 19% of multiple dissections. Extracranial dissections presented with infarct (82%) (major 52%, multifocal 16%, focal 28% e watershed 4%), cervical pain and/or headache (38%) incomplete Horner syndrome (14%). The intracranial dissections presented with infarct, intracranial hypertension and hydrocephalus, subarachnoid hemorrhage and brain haematoma. Most common angiographic findings in the extracranial carotid dissections were stenosis with slow flow (66%), occlusion (34%) and dissecting aneurysm (7%). In the extracranial vertebral dissections the angiograms depicted stenosis with slow flow (82%), occlusion (18%) and dissecting aneurysm (18%). In the intracranial dissections stenosis and dissecting aneurysm were equally found. Extracranial arterial dissections have are an important cause of stroke in the younger population. Anti thrombotic drugs are used for the treatment of dissections presenting with infarct. Refractory extracranial dissections and intracranial dissection with haemorrhage presentation and/or dissecting aneurysms should be managed by endovascular treatment.