Vertebral artery dissection vad is a flaplike tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. Comparison of test performance characteristics of mri, mr. There have only been 10 cases of vad caused by aad been reported. Vertebral artery dissection causes pain in the occiput and neck, but may radiate anteriorly to the orbits. We describe the efficacy and limitations of this method. It is usually diagnosed with a contrastenhanced ct or mri scan. Endovascular treatment with stent placement or stentassisted coiling was recently introduced as an alternative to parent artery occlusion in intracranial vertebral artery dissections.
Background and purpose intracranial vertebral artery dissection is an increasingly recognized cause of stroke. Dissection involves the pharyngeal and distal parts of the internal carotid artery, whereas atherosclerosis usually affects the origin and the carotid bulb. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. Review carotid and ve artery dissect practical neurology. Mri in vertebral artery dissection journal of neurology. Vertebral artery dissection vad is often a clinically elusive diagnosis, given a range of presentations depending on the presence or absence of precipitating factors, often nonspecific clinical symptoms, and varied symptomatology depending on where along the vertebral artery a.
Spontaneous dissection of the vertebral artery svad is a potentially disabling and probably underdiagnosed cause of stroke mainly affecting young adults. Magnetic resonance imaging and vertebral artery dissection. As the blood collects in the area of the dissection, it forms a clot that limits blood flow through the artery. Craniocervical artery dissection accounts for approximately 2% of all ischemic strokes, but 10% to 25% of strokes in young and middleaged patients. Provenzale1,2 basar sarikaya1,3 provenzale jm, sarikaya b 1department of radiology, duke university. Ideal sources for wikipedia s health content are defined in the guideline wikipedia. Silbert et al headache and neck pain in spontaneous carotid and vertebral artery dissections, neurology 4515171522, 1995.
These conditions have similar aetiology but different clinical presentations. Carotid or vertebral artery dissection is the result of a tear in the vessel lining wherein the intima separates the media. Diagnosis and management of vertebral artery stenosis article pdf available in qjm. It arises from the distal cervical internal carotid artery usually between the c1 and c3 vertebral bodies, passes through an enlarged hypoglossal canal, and joins the proximal basilar artery figs. However, little is known about its natural history and clinical manifestations, and appropriate management protocol has not yet been established. Spectrum of magnetic resonance imaging findings in vertebral. Internal carotid artery dissection has been extensively studied and welldescribed. Blood leaks through this tear and spreads between the layers of the wall. Firstly, the authors described the sensitivity and specificity of digital subtraction angiography dsa, magnetic resonance imagingangiography mri a, and duplex sonography for diagnosing extracranial. Dissection of the craniocervical arteries is a diagnosis that can be very difficult on crosssectional imaging studies such as ct angiography, mri, and mr angiography. Results showed concordance of mri and angiographic findings, in all cases but one. Specifically, the extracranial carotid artery is the most common site of arterial dissection, with an incidence estimated at 2. Cads include icds and vertebral artery dissections vads.
Vertebral artery occlusion with vertebral arterytoposterior inferior cerebellar artery stenting for preservation of the pica in treating ruptured vertebral artery dissection. The trip database provides clinical publications about. Cervical artery dissection cad may affect the internal carotid andor the. Although there has been a recent increase in the number of reported cases of vertebral artery va dissection, the clinical variety of presentation and the early warning symptoms have not been welldescribed before. Imaging of the pathology of the vertebral arteries. Vertebral artery dissection caused by chiropractic. Ct showed r vertebral artery dissection, mri mra showed l pontine infarct, r inferior cerebellar infarct, and narrowing of the r vertebral artery to less then 2 mm distal to the r pica. Clinical and neuroradiological features of intracranial. In each arterial system, the segment of the artery involved can be extracranial dissection involving the artery in the neck before it enters the cranium or intracranial when dissections affect the intracranial part of the artery box. Mri confirmed the vertebral artery dissection, with occlusion of the left vertebral artery, and a stenosis 70% of the right vertebral artery, without any image of ischemic stroke figure 3.
Cervical artery dissection in stroke study clinical. Fortyeight percent of the patients were hypertensive. A recent study assessed the sensitivity of ultrasound as compared with mri of the neck and mra for the detection of cervical artery dissection in 52 patients. Recently, va dissection has become increasingly recognized as a source of stroke and subarachnoid hemorrhage sah. Vertebral artery dissection vad is an increasingly recognized cause of stroke in patients younger than 45 years.
Nevertheless, it is also true that the use of a highresolution acquisition is important, especially for the study of vertebral arteries, frequently small in caliber. Imaging of cervical artery dissection sciencedirect. Endovascular treatment of intracranial vertebral artery. Since the advent of advanced radiological modalities such as mri and magnetic resonance angiography mra, dissections of cervical arteries are increasingly recognised as a common cause of stroke in young adults. Magnetic resonance imaging and clinical factors associated with. Fifteen patients were observed between 1987 and 1990. The proximity of the vertebral artery to the c1 and c2 vertebral bodies may play an important role in the development of dissection associated with neck movement. Review carotid and vertebral artery dissection syndromes. Tof mra mainly reflects the blood flow within the artery, representing the.
Pdf diagnosis and management of vertebral artery stenosis. Additional sequences in the imaging of vertebral artery dissection. Neck xray, with odontoid views but if they are having an event in the posterior fossa, ct is next to useless, so just go with the mri mri ptt, aptt, inr mri angiography will show yo ur dissection. Mri and mr angiography of vertebral artery dissection.
The symptoms of vertebral artery dissection include head and neck pain and intermittent or permanent stroke. Causes of misinterpretation of crosssectional imaging. Clinical and angiographic features and outcome in 25 patients with spontaneous dissections of the vertebral arteries are described. Angiographic evidence of fibromuscular dysplasia was noted in one only. Cervical artery dissection encompasses dissections of both the carotid and vertebral arteries. Management of dissections of the carotid and vertebral. Therapeutic progress in treating vertebral dissecting. Spontaneous dissections of the vertebral arteries neurology. Intracranial cerebral artery dissection contraindications to either antiplatelet or anticoagulation drugs, including active peptic ulceration or bleeding peptic ulcer within 1 year use of antiplatelet or anticoagulation drugs for other reasons e. Abstract we report a case of spontaneous vertebral artery dissection vad in a patient who developed extensive subcutaneous emphysema following the removal of a chest tube after a cardiac transplant. Atlantoaxial dislocation aad rarely leads to vertebral artery dissection vad. On close observation, axial gre brain sequences showed true and.
Support for individuals who had a verterbral artery dissection or familyfriends of a vad survivor. This creates a false or pseudo lumen, often accompanied by hemorrhage into the arterial wall. Most patients were in their fourth or fifth decade of life, and women predominated. Fourteen patients with intracranial vertebral artery dissection were treated with stent placement 10 patients or. T he primary presentation of an unruptured intracranial vertebral artery va dissection is severe occipital headache only or. In vivo accuracy of multispectral magnetic resonance imaging for identifying lipidrich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques.
The treatment of spontaneous carotid and vertebral artery dissections. Dissection of either the internal carotid artery or the vertebral artery cervicocephalic arterial dissection was once considered uncommon. Vertebral dissection may occur after physical trauma to the neck, such as a blunt injury e. When the vessel wall is torn, blood pools inside the artery and begins to clot. Unruptured intracranial vertebral artery dissection stroke. Although vertebral and carotid artery dissections are unusual events occurring in 2. Craniocervical artery dissection presents in a variety of ways including headache and neck pain, oculomotor horners syndrome as in our patient, and signs of cerebral ischemia that may be delayed by hours or days. Vertebral artery dissection, like arterial dissection elsewhere, is a result of blood entering the media through a tear in the intima. The study enhances the difficult diagnostic task of.
Crescent sign of arterial dissection the crescent sign refers to the high signal crescent seen in the wall of a vessel when dissected. Vertebral artery dissection is the tearing of the wall of a vessel carrying blood to the brain. Similarly, dissections affect distal parts of the extracranial vertebral artery, whereas atherosclerosis tends to involve the proximal segments. Cad is involved in nearly 2% of all cerebrovascular accidents in the general population and nearly 20% of cva in patients over 45 years of age. Gradient echoadditional track sign for easy detection of vertebral. The article by naggara et al 1 on the added value of highresolution mr imaging in the diagnosis of vertebral artery dissection shows an interesting comparison between routine clinical mr imaging examinations as performed in their institution and highresolution imaging acquired with dedicated coils and different techniques. This may be why the v3 segment is a frequent site of dissection, although dissec. Vertebral artery dissection support has 2,554 members. Mri brain angiography showed poor visualization of left vertebral. Ultrasound diagnosis of cervical artery dissection. Fukuda k, higashi t, yoshioka t, shigemori y, iwaasa m, miki k. I was determined to be stable eight days afterwards, and started inpatient rehab, which was great. Cervical artery dissection begins as a tear in one layer of the artery wall. Although its pathophysiology and treatment closely resemble that of its sister condition, carotid artery dissection cad, the clinical presentation, etiology, and epidemiological profile of vads are unique.
Detection of atherosclerosis using a novel positronsensitive probe. Dissection of the internal carotid artery or the vertebral artery va causes only 0. Clinical evaluation suggested vertebral artery dissection at the second cervical vertebra. The treatment of spontaneous carotid and vertebral artery. Vertebral artery dissection support public group facebook. Aan members 800 8791960 or 612 9286000 international nonaan member subscribers 800 6383030 or 301 2232300 option 3.
The persistent hypoglossal artery is the second most common carotidvertebrobasilar variant, present in 0. In a recent report, auer et al described the clinical and imaging findings in 19 cases of extracranial vertebral artery dissection retrospectively. Vertebral artery dissections have an incidence of 15 per 100,000 10,11. In addition, imh detection can be made more reliable with heavily t1weighted sequences. It is potentially lethal and can be difficult to diagnose clinically and radiologically. However, recent data show that cervical artery dissection is a possible. The v1 and v3 segments of the vertebral artery are the most mobile caplan et al. However, in the past few decades, it has been increasingly recognized as a cause of stroke in young and middleaged adults. Mri in spontaneous dissection of vertebral and carotid. The angiogram revealed severe narrowing of the right vertebral artery at the level of c12. Craniocervical arterial dissection rsna publications online.
Ppt vertebral artery dissection powerpoint presentation. One patient with incidental discovery at arteriography of asymptomatic vertebral artery dissection and two patients with acute strokes with mri and mra findings consistent with vertebral artery dissection were included. Abstractvertebral artery dissection vad, a wellrecognized cause of. Conventional angiography might be avoided altogether in subjects with a.
Craniocervical artery dissection is a potentially disabling yet probably. Cad are defined as the presence of a mural haematoma in the wall of an artery leading into the intracranial space. Vertebral dissection may cause unilateral or bilateral occipital lobe infarction or involvement of the brainstem with subsequent diplopia, nystagmus, and other eye movement disorders. It can occur in either of the two branches of these neck arteries as a result of trauma, or can arise spontaneously as a consequence of connective tissue disease. Details of the image vertebral artery dissection modality. Documents signs and symptoms in 161 patients with dissection. Cervical artery dissection, including carotid artery and vertebral artery dissection, is associated in at least 20% of young adult patients with stroke. Imaging of carotid artery dissection pubmed central pmc. Pdf magnetic resonance imaging and vertebral artery. Again it seems that the use of more appropriate sequences, probably more than that of a dedicated coil, helps in the diagnosis of vertebral artery dissection.
The three cases illustrate the clinical versatility of the vertebral artery dissection with two. Conventional angiography might be avoided altogether in subjects with a suspicious. Dissection of the internal carotid and vertebral arteries. Cervical artery dissection cad is an increasingly commonly identified cause of cerebrovascular accidents. Antiplatelet drugs, cerebrovascular disease, dissection, magnetic resonance imaging, vertebrobasilar disease neurosurgery 69. Vertebral artery dissection an overview sciencedirect. Auer et al 1recently advocated mra as the initial diagnostic tool for vertebral artery dissection. Diagnosis and treatment of vertebral artery dissection.
Mean age in vertebral artery dissection is 51 years and in carotid dissections. Mri with t1 sequences after fat saturation in axial slices a, flair in the axial plane. Vertebral artery dissection vad is an important cause of. Vessel wall imaging of the intracranial and cervical carotid arteries. Vertebral artery dissection after iatrogenic cervical.
No case of subarachnoid hemorrhage due to intracranial vertebral artery dissection studied with mri has been reported until now, to our. Vertebral artery dissection radiology reference article. Intracranial artery atherosclerosis, dissection, moyamoya disease. Imaging characteristics of symptomatic vertebral artery. Imaging studies showed a left internal carotid artery dissection extending up to the base of the skull.
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