Cases Of Cervical Artery Dissection Research Articles

Association between atherosclerotic disease and cervical artery dissection in a population-based cohort of older people.

Many cases of cervical artery dissection are considered "spontaneous." Recent data suggest that while cervical artery dissection may proportionally explain more strokes in young patients, hospitalization for dissection increases with age, suggesting a potential role of acquired vascular disease. In this study, we hypothesized that traditional vascular risk factors and comorbidities are associated with cervical artery dissection. We performed a retrospective cohort study using administrative claims data from a 5% sample of Medicare beneficiaries. Exposures of interest included traditional vascular risk factors and comorbidities: coronary artery disease, hyperlipidemia, hypertension, diabetes mellitus, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, valvular heart disease, atrial fibrillation, tobacco use, and alcohol abuse. The primary outcome was a new diagnosis of cervical artery dissection. Marginal structural Cox models were used to characterize the association between the exposures and outcomes, adjusted for time-dependent confounding. Among 2,256,710 eligible Medicare beneficiaries, 730 (0.03%) developed cervical artery dissection. The following exposures were found to be significantly associated with the development of cervical artery dissection: hypertension (HR 1.84 [95% CI: 1.40-2.41]), alcohol use (HR 1.83 [1.52-2.21]), atrial fibrillation (HR 1.80 [1.53-2.11]), tobacco use (HR 1.80 [1.52-2.13]), coronary artery disease (HR 1.56 [1.33-1.82]), and valvular heart disease (HR 1.23 [1.05-1.45]). In a large cohort of older people, several traditional vascular risk factors and comorbidities were associated with subsequent cervical artery dissection. Further studies exploring the role of such factors in the development of cervical artery dissection are warranted.

Cervical Spine Manipulation and Causation of Cervical Artery Dissection: A Review of 10 Case Reports.

Recent media coverage of high-profile cases of cervical artery dissection (CAD) has ignited the discussion about the role of cervical spine manipulation (CSM) in causing cervical artery dissection. However, research does not support a causal association between cervical spine manipulation and cervical artery dissection in a healthy cervical spine. The objective of this study was to review the 10 most recent case reports of cervical spine manipulation and cervical artery dissection for convincing evidence of the causation of cervical artery dissection by cervical spine manipulation. Nine of 10 case reports showed no convincing evidence of a causal relationship between cervical spine manipulation and cervical artery dissection. The 10th case report was exceptional as the CSM was contraindicated by pre-existing cervical spine pathology. We conclude that these 10 case reports provide no convincing evidence of the causation of cervical artery dissection by cervical spine manipulation in a healthy cervical spine. One case report demonstrated that cervical spine manipulation can cause cervical artery dissection when performed in the presence of pre-existing cervical spine pathology. Therefore, we conclude that practitioners should exclude cervical spine pathology before performing cervical spine manipulation.

Peripheral Blood Gene Expression Profiling Reveals Molecular Pathways Associated with Cervical Artery Dissection.

Cervical artery dissection (CeAD) is the primary cause of ischemic stroke in young adults. Monogenic heritable connective tissue diseases account for fewer than 5% of cases of CeAD. The remaining sporadic cases have known risk factors. The clinical, radiological, and histological characteristics of systemic vasculopathy and undifferentiated connective tissue dysplasia are present in up to 70% of individuals with sporadic CeAD. Genome-wide association studies identified CeAD-associated genetic variants in the non-coding genomic regions that may impact the gene transcription and RNA processing. However, global gene expression profile analysis has not yet been carried out for CeAD patients. We conducted bulk RNA sequencing and differential gene expression analysis to investigate the expression profile of protein-coding genes in the peripheral blood of 19 CeAD patients and 18 healthy volunteers. This was followed by functional annotation, heatmap clustering, reports on gene-disease associations and protein-protein interactions, as well as gene set enrichment analysis. We found potential correlations between CeAD and the dysregulation of genes linked to nucleolar stress, senescence-associated secretory phenotype, mitochondrial malfunction, and epithelial-mesenchymal plasticity.

Coronavirus Disease 2019 Infection in Cervical Artery Dissections.

Most cervical artery dissection (CeAD) cases are spontaneous or due to minor traumas, and preceding viral infections have been suggested to be a triggering event for CeAD in some. Herein, we analyze the prevalence of coronavirus disease 2019 (COVID-19) in hospitalized patients with CeAD using a national database. The National Inpatient Sample was queried from April 2020 to December 2020 for patients with a diagnosis of CeAD using International Classification of Diseases, 10th edition-Clinical Modification codes. Among these, patients with COVID-19 were identified. Multivariable logistic regression was conducted to assess the patient profile of those with COVID-19, in-patient mortality, and home discharge among patients with CeAD. There were 360 (2.32%) hospitalizations involving COVID-19 among 15,500 with CeAD. Concomitant acute ischemic stroke constituted 43.06% of those with a COVID-19 diagnosis, whereas it was 43.73% among those without a COVID-19 diagnosis (P = 0.902). Home discharges were less common in patients with COVID-19 and CeAD compared to CeAD alone (34.85% vs. 48.63%; P = 0.03), but this was likely due to other factors as multivariate regression analysis did not show an association between COVID-19 and home discharges (odds ratio: 0.69; 95% CI: 0.39 to 1.25; P = 0.22). COVID-19 diagnosis had similar odds of inpatient mortality (odds ratio: 1.11; 95% CI: 0.43 to 2.84; P = 0.84). The prevalence of COVID-19 among hospitalized patients with CeAD is low with 2.32% of all CeAD cases. Concomitant COVID infection did not lead to an increased risk of stroke in CeAD. However, potentially worse functional outcomes (fewer home discharges) without an increase in mortality were seen in patients with COVID and CeAD.

Reversible Cerebral Vasoconstriction Syndrome associated to Cervical Artery Dissection: Two Cases and Review of the Literature. (P11-5.012)

<h3>Objective:</h3> The purpose of this study was to describe the association between Reversible Cerebral Vasoconstriction Syndrome (RCVS) and Cervical Artery Dissection (CAD) in two cases and to review the literature discussing potential explanations for the association. <h3>Background:</h3> RCVS and CAD are infrequent and potentially underdiagnosed pathological conditions. There are few case reports with simultaneous occurrence of both conditions. A potentially common underlying physiopathological mechanism is still unknown. <h3>Design/Methods:</h3> Retrospective study of consecutive cases of patients diagnosed with RCVS and/or CAD from January 2010 to June 2021 in a neurological institute in Buenos Aires, Argentina. Demographic, clinical, laboratory, and neuroimaging data were collected and reviewed. Possible predisposing factors, clinical course and treatment were also recorded. Literature review was performed using online search engine PubMed, until June 2021. <h3>Results:</h3> Seventy-three SVCR cases and 256 CAD cases were included. Only 2 patients had RCVS and CAD simultaneously. RCVS and CAD diagnosis in those two cases were made simultaneously. Both cases received treatment for CAD and RVCS and had good outcomes, without ischemic or hemorrhagic complications. These 2 cases add to 9 case reports and a case series of 20 patients published in the literature. <h3>Conclusions:</h3> The association between RCVS and CAD is infrequent and the pathophysiological mechanisms are still uncertain. Nonetheless, it is convenient to study intracranial and extracranial vasculature in all patients since the simultaneous diagnosis of these entities modifies the therapeutic plan and care. <b>Disclosure:</b> Dr. Ricciardi has nothing to disclose. Maia Gomez Schneider has nothing to disclose. Dr. Ruiz Yanzi has nothing to disclose. Mr. Garat has nothing to disclose. Dr. Alessandro has nothing to disclose. Dr. Dossi has nothing to disclose. Dr. Pujol Lereis has nothing to disclose. Dr. Ameriso has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PHRI. Dr. Ameriso has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Bayer, Boehringer, Abbott, AstraZeneca.

Cervical Artery Dissections: Etiopathogenesis and Management.

Cervical Artery Dissection (CeAD) is a frequent stroke etiology for patients younger than 50 years old. The most common immediate complications related to CeAD are headache and neck pain (65–95%), TIA/ischemic stroke (>50%), and partial Horner’s syndrome (25%). The prevailing hypothesis regarding the pathogenesis of sCeAD is that the underlying constitutional vessel wall weakness of patients with sCeAD is genetically determined and that environmental factors could act as triggers. The stroke prevention treatment of CeAD remains controversial, involving anticoagulation or antiplatelet therapy and potentially emergent stenting and/or thrombectomy or angioplasty for selected cases of carotid artery dissection with occlusion. The treatment of headache associated with CeAD depends on the headache phenotype and comorbidities. Radiographically, more than 75% of CeAD cases present with occlusion or non-occlusive stenosis. Many patients demonstrate partial and complete healing, more commonly in the carotid arteries. One-fifth of the patients develop dissecting pseudoaneurysm, but this is a benign clinical entity with an extremely low rupture and stroke recurrence risk. Good recovery is achieved in many CeAD cases, and mortality remains low. Family history of CeAD, connective tissue disorders like Ehlers-Danlos syndrome type IV, and fibromuscular dysplasia are risk factors for recurrent CeAD, which can occur in 3–9% of the cases. This review serves as a comprehensive, updated overview of CeAD, emphasizing etiopathogenesis and management.

A case of cervical artery dissection in a young woman with repeated spontaneous coronary artery dissection

Background and Aims : Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction that mainly occurs in young women with no risk factors and no coronary atherosclerosis. SCAD aetiology is poorly understood. Familial cases have been described and rare cases are reported in association with hereditary connective tissue disorders, but most cases of SCAD are sporadic. SCAD can usually be diagnosed angiographically and there is a growing consensus in favour of conservative management when possible.

Influenza-Like Illness Is Associated With Increased Short-Term Risk of Cervical Artery Dissection

Abstract Introduction Non-traumatic Cervical Artery Dissection (CeAD) is a leading cause of ischemic stroke in the young. Influenza-like illnesses (ILI) trigger ischemic strokes. We hypothesized that influenza and ILI are associated with CeAD. Methods In a case-crossover study within the New York State (NYS) Department of Health Statewide Planning and Research Cooperative System (2006–2014), we used ICD-9 codes to exclude major trauma and to define CeAD, influenza, and the Centers for Disease Control defined ILI. We estimated the association of ILI and influenza with CeAD by comparing their prevalence in intervals immediately prior (0–30,0–90,0–180, and 0–365 days) to CeAD (case period) to their prevalence exactly one and two years earlier (control periods). Conditional logistic regression models generated odds ratios and 95% confidence intervals (OR, 95% CI). Models were adjusted for NYS estimates of influenza prevalence rates. Results Our sample included 3,610 cases of CeAD (mean age 52±16 years, 54.7% male, 6.2% Hispanic, 9.9% Black, 68.7% White). During case periods, 7.3% had one or more ILI. ILI was more likely within 90 days of CeAD compared to the same time interval one and two years before (0–15 days: adjusted OR 1.88, 95%CI 1.20–2.94; 0-30 days: adjusted OR 1.74, 95%CI 1.22–2.46; 0–90 days: adjusted OR 1.35, 95%CI 1.00–1.81). Influenza trended with CeAD (adjusted OR 1.86, 95%CI 0.37–9.24), but these results were not statistically significant, due to limited instances of confirmed influenza. Conclusions ILI may increase risk of CeAD for 15 days, and possibly up to three months.

Influenza-Like Illness is Associated with Increased Short-Term Risk of Cervical Artery Dissection

IntroductionNon-traumatic Cervical Artery Dissection (CeAD) is a leading cause of ischemic stroke in the young. Influenza-like illnesses (ILI) trigger ischemic strokes. We hypothesized that influenza and ILI are associated with CeAD. MethodsIn a case-crossover study within the New York State (NYS) Department of Health Statewide Planning and Research Cooperative System (2006–2014), we used ICD-9 codes to exclude major trauma and to define CeAD, influenza, and the Centers for Disease Control defined ILI. We estimated the association of ILI and influenza with CeAD by comparing their prevalence in intervals immediately prior (0–30,0–90,0–180, and 0–365 days) to CeAD (case period) to their prevalence exactly one and two years earlier (control periods). Conditional logistic regression models generated odds ratios and 95% confidence intervals (OR, 95% CI). Models were adjusted for NYS estimates of influenza prevalence rates. ResultsOur sample included 3,610 cases of CeAD (mean age 52±16 years, 54.7% male, 6.2% Hispanic, 9.9% Black, 68.7% White). During case periods, 7.3% had one or more ILI. ILI was more likely within 90 days of CeAD compared to the same time interval one and two years before (0–15 days: adjusted OR 1.88, 95%CI 1.20–2.94; 0-30 days: adjusted OR 1.74, 95%CI 1.22–2.46; 0–90 days: adjusted OR 1.35, 95%CI 1.00–1.81). Influenza trended with CeAD (adjusted OR 1.86, 95%CI 0.37–9.24), but these results were not statistically significant, due to limited instances of confirmed influenza. ConclusionsILI may increase risk of CeAD for 15 days, and possibly up to three months.

Traumatic Dissection of Arterial Cervical Vessels: Report of Two Cases and Literature Review

AbstractEven though traumatic dissection of cervical arterial vessels is the major cause of stroke among adults, it is still an underdiagnosed disease in neurosurgical emergencies, since most patients do not have or present subtle clinical signs in the acute phase. The authors report two interesting cases of cervical artery dissection with different traumatic mechanisms and present a broad literature review about this subject.

Abstract TMP60: Association Between Pregnancy and Cervical Artery Dissection

Background and Purpose: Pregnancy is a risk factor for stroke. The mechanisms of stroke in pregnancy have not been well established. Cervical artery dissection may be one such mechanism, but it is unclear whether pregnancy is a risk factor for cervical artery dissection. Methods: We performed a cohort-crossover analysis using administrative claims data from all hospitalizations and emergency department visits involving nonfederal acute care hospitals in NY and FL between 2005-2015. We identified women ≥12 years old who were hospitalized for labor and delivery. Our outcome was cervical artery dissection, defined as carotid or vertebral artery dissection. We defined the period of risk as 6 months antepartum through 3 months postpartum. We compared each patient’s risk of dissection during this time period versus the corresponding 270-day period exactly 1 year later. Conditional Poisson models with robust standard errors were used to calculate incidence risk ratios (IRRs). Results: We identified 4,193,417 pregnancies among 3,061,413 women during our study period. There were 52 cases of cervical artery dissection during the peripartum period and 24 cases during the control period 1 year later. The incidence of cervical artery dissection was 12 (95% CI, 10-17) per million pregnancies versus 6 (95% CI, 4-9) per million patients during the control period 1 year later (IRR, 2.2; 95% CI, 1.3-3.5). Our findings were similar when we limited our outcome to cervical artery dissections complicated by ischemic stroke (IRR, 2.3; 95% CI, 1.1-5.1). Secondary analyses suggested that the heightened risk occurred in the peripartum and postpartum period (IRR,5.5; 95% CI, 2.6-11.7), not the antepartum period (IRR, 0.5; 95% CI, 0.2-1.2). Conclusions: In a large, population-based sample of women, pregnancy was associated with an increased risk of cervical artery dissection. This increased risk appeared to be limited to the peripartum and postpartum period.

Abstract WMP49: Influenza-Like Illness May Trigger Cervical Artery Dissection

Background and Purpose: Non-traumatic Cervical Artery Dissection (CeAD) is a leading cause of ischemic stroke in patients 15 to 45 years old. Influenza-like illnesses (ILI) have been found to trigger ischemic stroke, but ILI has not been investigated in relation to CeAD. We hypothesized that ILI and influenza would be associated with CeAD. Methods: We used a case-crossover design among patients &gt; 18 years old at time of first non-traumatic CeAD within the New York State (NYS) Department of Health Statewide Planning and Research Cooperative System (2006-2014). We used ICD-9 codes to define CeAD (443.21, 443.24) excluding individuals with major trauma (integer values 800-804 and 850-854), confirmed influenza (480, 487.0, 487.1, 487.8), and a broader influenza definition endorsed by the CDC for ILI surveillance. We compared ILI and influenza in sequential, mutually exclusive intervals preceding CeAD (0-15, 16-30, 31-90, 91-180, and 181-365 days prior to CeAD: case period) and overlapping intervals (0-30, 0-90, 0-180, and 0-365 days prior to CeAD: alternate case period) to ILI and influenza exactly one and two years earlier (control periods). Conditional logistic regression models were used to calculate odds ratios and 95% confidence intervals (OR, 95% CI) before and after adjusting for annual NYS population estimates of influenza prevalence rate. Results: Our final sample included 3,861 cases of CeAD (mean age 52±16 and 55.5% of male). We found 1,736 instances of ILI and 113 of influenza during the 3 years preceding CeAD. Patients were more likely to have ILI within 30 days of CeAD compared to the same time one and two years before (0-15 days: adjusted OR 1.53, 95% CI 1.02 - 2.30; 0-30 days: adjusted OR 1.60, 95% CI 1.14 - 2.23). ILI during later overlapping or sequential intervals was not associated with CeAD in adjusted models. Influenza was associated with CeAD between 31 and 90 days after CeAD, but this effect was no longer significant after adjusting for prevalence rate of influenza, perhaps due the small number of patients with confirmed influenza. Conclusions: ILI may increase risk of CeAD for up to one month. Further research on mechanisms by which ILI and influenza may trigger dissection are warranted.

Cervical Artery Dissection in Patients of African Ancestry

Background and Purpose: The majority of published data in cervical artery dissection (CeAD), a common cause of stroke in young adults, derive from populations of European ancestry (EA), including a recent genome-wide study identifying an association with the rs9349379 polymorphism of the PHACTR1 gene. Little is known about CeAD in individuals of African ancestry (AA) despite robust epidemiological data showing increased risk of stroke at younger ages. We hypothesize that AA patients with CeAD have different epidemiology and clinical profiles compared to those of EA, and a different genetic architecture related to rs9349379 of the PHACTR1 gene. Methods: We searched a single-center database of CeAD to identify AA and EA patients. We compared differential prevalence of CeAD versus all young stroke between AA and EA patients. We characterized clinical profiles via electronic medical record review. Data include descriptive statistics reported as medians or percentages. We also obtained publicly available allele frequencies of rs9349379 in AA and EA populations. Results: AA patients comprise 7% of CeAD cases and 27% of young stroke cases while EA patients comprise 90% of CeAD cases and 70% of young stroke cases. Prevalence of hypertension, diabetes mellitus, and hyperlipidemia were 74, 30, and 50%, respectively, in AA patients compared to 37, 6, and 25% in EA patients. Allele frequencies for the CeAD risk allele, rs9349379(A), are higher in AA populations compared to EA populations. Conclusion: AA patients represent a smaller proportion of CeAD cases compared to young stroke cases at our center. AA patients suffering CeAD have higher prevalence of both vascular risk factors and frequency of the CeAD risk allele compared to EA patients. These findings suggest a complex interplay between traditional vascular risk factors and genetic predisposition underlying CeAD pathogenesis. Further prospective research is needed to clarify these associations and disparities.

Spontaneous cervical artery dissection: a fluoroquinolone induced connective tissue disorder?

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.

P.092 Eagles and Talons: A case of cervical artery dissection from Eagle syndrome and fibromuscular dysplasia

Background: Eagle syndrome (also known as stylohyoid syndrome) and fibromuscular dysplasia (FMD) are rare conditions that have both been shown to be associated with cervical artery dissections (CAD). Direct mechanical injury from a neighboring bony fragement can produce arterial dissections and is the proposed mechanism in Eagle syndrome. The etiology of FMD remains unclear, however, similar shearing stresses have been proposed. We present a case in which both of these conditions were present. Methods: Case report Results: A previously healthy 52 year old male presented with an acute left MCA syndrome with computer tomography angiography followed by convensional angiography confirming a complete occlusion of the left ICA at the carotid bifurcation with evidence of a dissection of the proximal cervical carotid artery. Luminal irregularities proximal to the dissection and also of the right ICA were in keeping with fibromuscular dysplasia. A carotid stent was placed and a thrombectomy was performed for a proximal left M2 occlusion. On further review of the CT, the patient had markedly elongated styloid processes bilaterally, meeting criteria for Eagle syndrome. Conclusions: Previous literature has not described these two conditions coexisiting. We question whether chronic mechanical stress from an elongated styloid process could lead to arteries having an irregular or beading appearance resembling fibromuscular dysplasia.

Abstract WMP45: Gene Expression Profile of Cervical Artery Dissection by Time of Event (CADEX Study)

Introduction: Cervical artery dissection (CeAD) of the carotid and vertebral arteries is a prevalent cause of stroke in young adults. While the pathogenesis of incident CeAD remains poorly understood, clinical and genetic associations suggest a systemic arteriopathy at time of event. Hypothesis: Individuals suffering CeAD express a distinct gene expression profile at time of event compared to (1) age and sex-matched controls and (2) convalescent profiles within the same individual at a later time point. Methods: We enrolled 37 consecutive patients with carotid or vertebral artery dissection (with and without ischemic stroke) from 2013-2016, excluding concurrence of major trauma. Cases were age and sex matched to non-CeAD ischemic stroke controls (n=16) and healthy controls (n=11). Whole blood samples were collected within four weeks from time of event, and again at 3 and 6-month follow-up. We used IlluminaHT-12 microarrays to assess differential gene expression at time of CeAD relative to controls, and relative to gene expression at &gt;3 month follow-up within CeAD cases. Mixed effects regression models included relevant covariates of age, sex, race/ethnicity, time of enrollment, and occurrence of stroke. We used a False Discovery Rate (FDR) cutoff of 5% to account for multiple testing as well as a 1.5 fold change cutoff to identify robust, differential gene expression. Results: We identified 538 differentially expressed genes between CeAD patients and healthy controls with 30 of these genes reaching our predetermined 1.5x fold change limit. Within CeAD cases, 1,238 genes showed differential expression at a 5% FDR compared to time points at 3-6 month follow-up, with 31 genes showing at least a 1.5 fold change. Compared to controls and convalescent profiles, 12 genes were significant using the 5% FDR and 1.5 fold change cutoffs. Preliminary gene-ontology analysis indicate the largest differential expression for genes associated with oxygen and gas transport. Conclusion: In this consecutive cohort of individuals with CeAD, we identified a distinct gene expression profile associated with incident dissection. These data are limited by small sample size and results are hypothesis generating. Replication in larger, independent cohorts is warranted.

Pulsatile tinnitus and carotid artery dissection

Carotid artery dissection is an uncommon entity associated with head and neck pain, partial Horner’s syndrome, amaurosis fugax, and brain ischemia, which may all occur in isolation or in combination. Herein, we report a rare case of cervical artery dissection in which pulsatile tinnitus was the only reported symptom. A 38-years-old man attended our hospital with a 4-days history of left side pulsatile tinnitus which began after stumbling. He had no other symptom. MRA showed luminal stenosis with pseudo lumen of the internal carotid artery. The patient was diagnosed with left internal carotid artery dissection and treated with antihypertensive therapy accordingly. After 2 months, the stenosis and tinnitus spontaneously resolved.

Seasonal Variation in Spontaneous Cervical Artery Dissection: Comparing between UK and Australian Sites

Cervical artery dissection (CAD) is a leading cause of stroke among middle-aged adults, but the etiology is unclear. Some reports of seasonal variation in CAD incidence have been suggested but may reflect extreme climatic conditions. Seasonal variation may implicate more transient seasonal causes such as proinflammatory or hypercoagulable states. This study aimed to assess whether CAD incidence varied with season between UK and Australian sites. Also, this study aimed to determine whether there was a different pattern of seasonal variation between arteries (carotid and vertebral) and any association between CAD incidence and clinical factors. This was a retrospective observational study of patients older than 18 years with radiological diagnosis of internal carotid or vertebral arterial dissection, from sites in Australia and the UK. Clinical variables were compared between autumn-winter and spring-summer and site of dissection. A total of 133 CAD cases were documented in Australia and 242 in the UK. There was a seasonal pattern to CAD incidence in countries in both the northern and the southern hemispheres, with a trend for dissection to occur more commonly in autumn, winter, and spring than in summer (incidence rate ratios [IRR] 1.4-1.5, P < .05). CAD counts were also slightly higher in internal carotid than in vertebral artery (IRRs 1.168, 1.43, and 1.127, respectively). Neither systolic blood pressure nor pulse pressure was significantly associated with CAD counts. CAD occurs more commonly in cooler months regardless of geographical location, suggesting transient seasonal causes may be important in the pathophysiology. This effect was slightly higher in internal carotid than in vertebral artery, suggesting differing trigger mechanisms between dissection sites.

Relationship between dyslipidemia and vascular repair after cervical artery dissection

AbstractBackgroundIn some cases of cervical artery dissection, vascular repair subsequently occurs at the stenotic or occluded sites. The factors responsible for this type of vascular repair remain unknown, but some reports from in vitro and animal models suggest that it is related to lipid metabolism.AimIn the present study, we investigated the relationship between vascular repair and dyslipidemia in cervical artery dissection.MethodsPatients with internal carotid artery and vertebral artery dissection who were admitted between April 2012 and March 2015 were included. Vascular repair was evaluated using magnetic resonance angiography. All patients were treated conservatively using antihypertensive and antiplatelet drugs, and also with statins in the presence of dyslipidemia. In this study, we investigated the relationship between vascular repair and dyslipidemia in cervical artery dissection.ResultsVascular repair was observed in 34 out of 55 patients (61.8%, repair group). Total cholesterol (203 mg/dL in repair group vs 225 mg/dL in non‐repair group), low‐density lipoprotein cholesterol (119 mg/dL vs 140 mg/dL), low‐density lipoprotein cholesterol/high‐density lipoprotein cholesterol ratio (2.09 vs 2.74) and triglycerides (117 mg/dL vs 154 mg/dL) were significantly negatively correlated with vascular repair. However, statin use was not significantly related to this type of repair.ConclusionsWe showed a relationship between vascular repair after cervical artery dissection and dyslipidemia. As cervical artery dissection often occurs at a relatively young age, vascular repair and the management of dyslipidemia are important issues to consider for the prevention of arteriosclerotic cerebrovascular diseases in later life.

Correction: The Quality of Reports on Cervical Arterial Dissection following Cervical Spinal Manipulation

The authors have found that some of the data contained in this manuscript are categorized inappropriately. Many of the cases included from two case-control studies (Rothwell et al. and Stevinson et al.) should be omitted from the paper’s calculations as they were reported originally as cervical artery dissection cases in general, but not cervical artery dissection cases that occurred prior to cervical manipulation. The total number of cases where cervical manipulation was reported to have occurred prior to the onset of cervical artery dissection should be reduced from 902 to 322. With this adjustment, the time to onset of symptoms can now be reported to be a smaller percentage of cases (89%) compared to the original paper (93%). Similarly, the percentage of cases that named the involved vessel increased from 71% to 77%. Finally, the percentage of cases reporting the profession of the involved clinician performing the manipulation decreased from 99% to 80%. Excluding these three variables, the other 15 variables in the paper remain unchanged. This reclassification of cases does not alter the conclusions of the paper.