Factors predisposing to cervical artery dissection
2011
Introduction. Cervical artery dissection is a major cause of cerebral
ischemia in young adults and can lead to various clinical symptoms, some of
which are benign (e.g. headache, neck pain, Horner’s syndrome, and cranial
nerve palsy). However, most patients have a stroke or transient ischemic
attack. Epidemiology. The incidence of cervical artery dissection is low and
is estimated to be around 2.6 per 100,000 inhabitants. Mortality and
short-term recurrence rates are low; however, they may have been
underestimated. Pathophysiology. Although the pathophysiology is still
unclear, constitutional and partly genetic susceptibility of the arterial
wall has been proposed as a causal factor, triggered by infection or minor
trauma. Predisposing factors. In addition to the trauma to the neck, other
risk factors have been suggested, such as infection, migraine,
hyperhomocisteinamia, and the 67TT genotype of the
5,10-methylene-tetrahydrofolate reductase gene although evidence is sparse.
Genetic factors. Cervical artery dissection is now considered a
multifactorial disease caused by several genetic abnormalities and
environmental factors acting synergistically. Conclusion. Research aimed at
improving our understanding of the environmental and genetic factors
predisposing to cervical artery dissection and assessment of long-term
outcomes of this disease is needed. Better understanding of the underlying
pathophysiology and the natural history of the disease through large
prospective multicentre cohorts could also be helpful to improve therapeutic
and preventive strategies. Several multicentre efforts are already under way
to meet these needs.
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