Extracranial and intracranial artery dissections: Experiences from a tertiary referral center

Abstract

Background:
 Craniocervical artery dissection is an important cause of ischemic stroke
 especially in young and middle aged adults. In this study, we evaluated
 extracrainal and intracranial artery dissections in terms of etiologies, risk
 factors, stroke severity and functional outcomes. 
 
 Methods: A
 total of 29 patients who were diagnosed with ischemic stroke due to
 extracranial or intracranial artery dissections were enrolled to this study.
 The ischemic stroke diagnosis was confirmed with diffusion weighted magnetic
 resonance imaging in all patients. Computed tomography angiography, magnetic
 resonance angiography and digital subtraction angiography were used to
 demonstrate the dissection. Demographic findings, risk factors and presence of
 trauma were evaluated. National Institute of Health Score Scale (NIHSS) was
 used for stroke severity assessment at disease onset. Functional outcomes were
 measured with Modified Rankin Scale (mRS) at the 3rd month. 
 
 Results:
 Fifteen patients (51.72%) had carotid artery dissections while 12 patients
 (41.37%) had vertebral artery dissection (VAD), 1 (3.4%) had basilar artery
 dissection (BAD) and both VAD and BAD were seen in 1 patient (3.4%).
 Coagulopathy was detected in 12 patients (41.37%). Connective tissue disease
 was suspected in 3 patients (10.3%). In 6 patients, dissections occured after
 trauma. Nineteen patients (65.51%) presented with somatosensory deficits. The
 3rd month mRS scores were in the range of 0-2 and no significant correlation
 was found in terms of risk factors, etiology and trauma history.
 
 Conclusion:
 Arterial dissection should be kept in mind for the clinical presentation of
 ischemic stroke in young adults. We think that better understanding of the risk
 factors, etiologies and clinical presentation of the dissections and early
 diagnosis-proper treatments might yield improved clinical outcomes.