vertebral artery dissection
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Introduction
Clinical manifestations
- balance impairment & visual loss common[2]
- Wallenberg syndrome via lateral medullary infarction[2]
- patients >= 60 years of age less likely to present with cervical pain (RR=0.47), headache (RR=0.58), or history of mechanical triggers (RR=0.53)[5]
- does not cause hemispheric stroke[7]
Complications
- distal embolization
- embolic stroke risk is low[4]
- thrombus formation at the site of dissection
- arterial thromboembolism[2]
- risk of recurrent stroke is 2.5% at 1 year[6]
Management
- see carotid artery dissection
- aspirin 81-325 mg PO QD for platelet inhibition better than heparin followed by warfarin[2]
- aspirin is not non-inferior to vitamin K antagonist (warfarin)[8]
- no evidence that antiplatelet agents or anticoagulants of benefit in reducing risk of recurrent stroke[6]
More general terms
Additional terms
References
- ↑ Kidwell CS and Burgess RE Dissection Syndromes eMedicine: Neurology http://en.wikipedia.org/wiki/Carotid_artery_dissection
- ↑ 2.0 2.1 2.2 2.3 2.4 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18, 19. American College of Physicians, Philadelphia 2012, 2015, 2018, 2021
- ↑ Caplan LR. Dissections of brain-supplying arteries. Nat Clin Pract Neurol. 2008 Jan;4(1):34-42 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18199995
- ↑ 4.0 4.1 The CADISS trial investigators. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): A randomised trial. Lancet Neurol 2015 Feb 12 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25684164 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2815%2970018-9/abstract
- ↑ 5.0 5.1 Traenka C, Dougoud D, Simonetti BG et al. Cervical artery dissection in patients >= 60 years: Often painless, few mechanical triggers. Neurology 2017 Apr 4; 88:1313 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28258079 <Internet> http://www.neurology.org/content/88/14/1313
- ↑ 6.0 6.1 6.2 Markus HS, Levi C, King A et al Antiplatelet Therapy vs Anticoagulation Therapy in Cervical Artery Dissection. The Cervical Artery Dissection in Stroke Study (CADISS) Randomized Clinical Trial Final Results. JAMA Neurol. Published online February 25, 2019 PMID: https://www.ncbi.nlm.nih.gov/pubmed/3080162 https://jamanetwork.com/journals/jamaneurology/fullarticle/2725385
- ↑ 7.0 7.1 7.2 NEJM Knowledge+ Question of the Week Feb 18, 2020 https://knowledgeplus.nejm.org/question-of-week/1356/
Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001 Mar 22; 344:898. https://www.nejm.org/doi/full/10.1056/NEJM200103223441206 - ↑ 8.0 8.1 Engelter ST et al. Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): An open-label, randomised, non-inferiority trial. Lancet Neurol 2021 Mar 22; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33765420 https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(21)00044-2/fulltext