Vertebral and carotid artery dissection: Difference between revisions
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==Background== | ==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 | *Dissections can occur in both anterior and posterior arterial systems | ||
*Symptoms may be transient or persistent | *Symptoms may be transient or persistent | ||
*Pathophysiology | |||
**Hematoma, platelet aggregation and thrombus formation compromise vessel patency | |||
===Risk Factors=== | ===Risk Factors=== | ||
# | #Neck trauma | ||
# | #Coughing | ||
#Connective tissue disease | #Connective tissue disease | ||
#History of migraine | #History of migraine | ||
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==Diagnosis== | ==Diagnosis== | ||
#MRI/MRA or CT/CTA | #MRI/MRA or CT/CTA | ||
==Treatment== | |||
#Anticoagulation | |||
==Source== | ==Source== | ||
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
- Neck trauma
- Coughing
- Connective tissue disease
- 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
- Unilateral HA (50-67%), face pain (10%), and/or neck pain (25%)
- 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
- Posterior neck pain (46%), HA (69%)
Diagnosis
- MRI/MRA or CT/CTA
Treatment
- Anticoagulation
Source
- Tintinalli