Discussion Author: Linda P Thomas
Spontaneous carotid and vertebral arterial dissections are recognized causes of stroke, especially in young and middle-aged patients without other risk factors for stroke. Cervical arterial dissection has been reported to often occur in healthy individuals without clear antecedent trauma or with only mild mechanical stress such as coughing, sudden head movement, infection or participation in sports. Arterial dissection occurs when there is a separation of the vessel wall. The separation is usually between the intima and media or within the media. Often dissection occurs because of an intimal tear resulting in a false lumen or intramural hematoma. Complications include stroke from emboli or hemodynamic compromise and rupture. If untreated, the false lumen can enlarge to compress the true lumen, rupture, persist or thrombose.
Although the causes of aortic dissections are frequently known (long standing hypertension, trauma, degradation of the media), the pathogenesis of spontaneous cervical arterial dissections is unknown. An underlying connective tissue disorder leading to arterial wall structural instability has been postulated and is supported by the high incidence of dissections in patients with heritable connective tissue disorders.
Diagnosis frequently can be made with Doppler sonography and confirmed with arteriography. Cervical arterial dissections are usually treated with anticoagulation.
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