Abstract
BackgroundSpontaneous cervical artery dissections more often manifest in young people and have been associated with catastrophic consequences. Some indeterminate risk factors have been identified, making the diagnosis of developing dissections quite difficult. Fluoroquinolone antibiotics have been recognized for their degradative effects on connective tissue. Recent studies have implicated fluoroquinolones in the genesis of aortic artery aneurysms. It is the purpose of this paper to provide reasoning for a testable hypothesis of whether fluoroquinolones constitute a risk factor associated with cervical artery dissections.MethodsA PubMed search was conducted to investigate whether cervical artery dissection has been associated with fluoroquinolone use. An assessment of risk factors was made of hereditary connective tissue disorders, infection, and seasonal predisposition related to cervical artery dissection. These factors were considered in conjunction with reports of connective tissue toxicity associated with fluoroquinolone medications.ResultsIt appears that no reported cases of cervical artery dissection have previously been correlated with fluoroquinolone use. Heritable connective tissue disorders, infection, seasonal predisposition and condition latencies are associated with fluoroquinolone medications. Several recent articles have implicated fluoroquinolones with aortic dissections and aneurysm.ConclusionA causal relationship of fluoroquinolone antibiotics to cervical artery dissection is plausible. The suppositions developed in this paper are insufficient to suggest that fluoroquinolones currently represent an established risk factor in the development of cervical artery dissections. Fluoroquinolones may indeed be a novel and previously unrecognized cause of cervical artery dissections.
Highlights
The primary objective of this paper is to provide a testable hypothesis whether fluoroquinolone antibiotics constitute a risk factor associated with spontaneous cervical artery dissections
A seasonal variation has been reported with cervical artery dissection more likely to occur in the winter [4]
Congenital risk factors Heritable disorders such as Ehlers-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta type 1, autosomal dominant polycystic kidney disease, and fibromuscular dysplasia have been reported as risk factors for cervical artery dissection [2]
Summary
The primary objective of this paper is to provide a testable hypothesis whether fluoroquinolone antibiotics constitute a risk factor associated with spontaneous cervical artery dissections.17-year study period, Lee et al reported a mean annual incident rate of 2.6 to 3.1 per 100,000 population [3]. The primary objective of this paper is to provide a testable hypothesis whether fluoroquinolone antibiotics constitute a risk factor associated with spontaneous cervical artery dissections. Extrapolating from a national database of outpatient antibiotic prescriptions in the United States, Suda et al reported an average of 24.5% more antibiotic prescriptions were dispensed in the winter months than in the summer, over a 5-year study period with a mean outpatient consumption of quinolone antibiotics of 13.66% [8] These combined factors may partially explain the seasonal variation and increased risk of dissection during winter months. Recent studies have implicated fluoroquinolones in the genesis of aortic artery aneurysms It is the purpose of this paper to provide reasoning for a testable hypothesis of whether fluoroquinolones constitute a risk factor associated with cervical artery dissections
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