Vertebral and carotid artery dissection: Difference between revisions

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*Pathophysiology
*Pathophysiology
**Hematoma, platelet aggregation and thrombus formation compromise vessel patency
**Hematoma, platelet aggregation and thrombus formation compromise vessel patency


===Risk Factors===
===Risk Factors===

Revision as of 08:49, 28 September 2011

Background

  • Most frequent cause of CVA in young and middle-aged patients (20% of cases)
  • Dissections can occur in both anterior and posterior arterial systems
  • Symptoms may be transient or persistent
  • Pathophysiology
    • Hematoma, platelet aggregation and thrombus formation compromise vessel patency

Risk Factors

  1. Neck trauma
  2. Coughing
  3. Connective tissue disease
  4. History of migraine

Clinical Features

  • Internal Carotid Dissection
    • Unilateral HA (50-67%), face pain (10%), and/or neck pain (25%)
      • Pain can precede other symptoms by hours-days (median 4d)
      • HA most commonly is frontotemporal, severity may mimic SAH or preexisting migraine
    • Partial Horner syndrome (miosis and ptosis)
    • CN palsies
  • Vertebral Artery Dissection
    • Posterior neck pain (46%), HA (69%)
      • May be unilateral or bilateral
      • HA is typically occipital
    • Unilateral facial paresthesia
    • Dizziness
    • Vertigo
    • N/V
    • Diplopia and other visual disturbances
    • Ataxia

Diagnosis

  1. MRI/MRA or CT/CTA

Treatment

  1. Anticoagulation

Source

  • Tintinalli
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