Cerebral Artery Dissection: Spectrum of Clinical Presentations Related to Angiographic Findings
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Abstract:
Cerebral arterial dissections are recognized as a common cause of stroke. However, few studies have reported on the distribution of cerebral arterial dissection and angiographic pattern related to the presenting clinical symptom pattern. We analyzed the distribution of cerebral artery dissection along with angiographic and clinical presenting a pattern as depicted on angiograms.From January 2000 to January 2007, 133 arterial dissection patients admitted to our institutes were retrospectively reviewed. The characteristic angiographic findings of all cerebral arteries were carefully evaluated on 4-vessel angiograms. The male-female ratio was 77: 56 and the mean age was 51 years. According to the angiographic finding depicting the location of the dissection plane in the arterial wall, we categorized to steno-occlusive, aneurysmal, combined and unclassifiable pattern. In each dissection pattern, we evaluated presenting symptoms and presence of infarction or hemorrhage.The most common symptom on presentation was headache (47%), followed by motor weakness of arm or leg (31%), dysarthria/aphasia (19%) and vertigo (16%). The most common angiographic pattern was steno-occlusive (46%), followed by combined (steno-occlusive and aneurismal) (27%) and aneurysmal (22%) patterns. Steno-occlusive pattern was most commonly related to infarction (33/61, 54%) in contrast that aneurysmal pattern was most frequently related to subarachnoid hemorrhage (SAH) (7/29, 24%). The most frequent abnormality in patients with dissection of the intradural vertebral arteries including posterior cerebral artery (PCA) was SAH (23/70, 33%), followed by infarction. Infarction was the most common abnormality in patients with the extradural and intradural carotid arteries, and the extradural vertebral artery.In contrast that the extradural arterial dissections tended to result in ischemia with steno-occlusive pattern, the intradural arterial dissections tended to result in SAH with aneurysmal type, especially in the vertebral artery. Dissection requires combined analysis of angiographic pattern and type of stroke depending on the location.Keywords:
Arterial dissection
Vertebral artery dissection
Stroke
Abnormality
BACKGROUND AND PURPOSE:
Pediatric vertebral artery dissecting aneurysm is a subtype of vertebral artery dissection that can be challenging to diagnose and may be associated with stroke recurrence. This study examines the presenting features, clinical outcomes, and recurrence risk in a cohort of children with vertebral artery dissection, comparing those with aneurysms with those without.MATERIALS AND METHODS:
The medical records of children evaluated for vertebral artery dissection were retrospectively reviewed for neurologic presentation, treatment, stroke recurrence, and angiographic appearance of dissection. Cohort patients were categorized into 2 groups based on the presence or absence of a vertebral artery dissecting aneurysm and compared via the Fisher exact test, Student t test, and log-rank analyses. P < .05 was deemed statistically significant.RESULTS:
Thirty-two patients met the inclusion criteria, including 13 with vertebral artery dissecting aneurysms. Five cases of vertebral artery dissecting aneurysm were missed on the initial evaluation and diagnosed retrospectively. All patients received antiplatelet or anticoagulation therapy at the time of diagnosis. Children in the vertebral artery dissecting aneurysm group were more likely to present with stroke (P = .059), present at a younger age (P < .001), and have recurrent stroke (P < .001) compared with the group of children with vertebral artery dissection without an aneurysm. After surgery, no patients with vertebral artery dissecting aneurysm experienced recurrent stroke (P = .02).CONCLUSIONS:
Vertebral artery dissecting aneurysm is often missed on the initial diagnostic evaluation of children presenting with stroke. In children with vertebral artery dissection, the presence of an aneurysm is associated with stroke presentation at a younger age and stroke recurrence.Vertebral artery dissection
Stroke
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Objective To assess the clinical features,diagnosis,therapy and the prognosis of vertebral artery dissection presented as ischemie cerebral vascular disease.Methods Clinical and routine laboratory examinations were performed in all the 6 patients,who underwent brain DSA,MRI,MRA and cervical vascular duplex ultrasound examinations.They fulfilled at least 1 of 2 imaging criteria used to diagnose vertebral dissection.Results There was sudden neck pain or occipital headache in 4 of the 6 eases.Vertigo and (or) dizziness were the main onset symptoms for all the subjects.Two cases presented Wallenberg syndrome; Three had recent trauma to the neck.DSA showed occlusion or stenosis of the vertebral artery.MRI showed an crescent-shaped intramural hematoma.Cervical vascular duplex ultrasound revealed normal intima-media thickness and no carotid atheroscleretic plaque,and displayed significant stenosis or occlusion of the involved vertebral artery.The dissections were found in the extracranial segment of the vertebral artery in 5 cases.The follow up period for all patients was approximately 26 months.The anticoagulant therapy was administered to all subjects for a period ranging from 9 to 53 months.The modified Rankin Scale (mRS)improved significantly as compared to baselines in all except for one ease,the mRS were4,4,4,2,2,2 vs 4,3,2,1,0,1 (Z=-2.07,P=0.038).Conclusions Vertebral artery dissection has unique clinical features.Neuroimnging is useful in confirming the diagnosis.The occlusive lesion of the involved vertebral artery is reversible under long-term anticoagulant treatment.The prognosis is relatively positive.
Key words:
Aneurysm,false; Vertebrobasilar insufficiency; Anticoagulants; Prognosis
Vertebral artery dissection
Cervical Artery
Vertebrobasilar insufficiency
Arterial dissection
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Vertebral artery dissection after neck manipulation has been well described. A case of bilateral vertebral artery dissection diagnosed with dynamic CT scanning of the neck is reported. The CT appearances and correlative angiographic and MR findings are presented.
Vertebral artery dissection
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We sought to identify the use of duplex and transcranial Doppler sonography in the noninvasive diagnosis of vertebral dissection.Ten patients with a diagnosis of symptomatic vertebral artery dissection confirmed by cerebral angiography were retrospectively analyzed.Computed tomographic scanning and magnetic resonance imaging together delineated lateral medullary or cerebellar infarcts in 7 patients. Angiography documented a total of 21 vertebral artery lesions (16 stenoses and 5 occlusions), with 7 of 10 patients having multiple sites of vertebral artery dissection. Vertebral Doppler was abnormal in 8 of the 10 patients. A high resistance signal in the relevant vertebral artery was found in 6 patients, no flow in a well-imaged vertebral artery in 1, and bilateral retrograde vertebral artery flow in 1 patient. Transcranial Doppler was abnormal in only 2 patients, with reduced pulsatility index in 1 and high resistance vertebral signal in another. A hyperintense intramural signal of the affected vertebral a...
Vertebral artery dissection
Transcranial Doppler
Magnetic resonance angiography
Duplex scanning
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Objective To analyze the clinical and radiological features of young stroke caused by vertebral artery dissection to discuss its therapy and outcome.Methods Nine patients with confirmed diagnosis of young stroke caused by vertebral artery dissection,admitted to our hospitals from January 2008 to December 2011,were chosen in our study; their history data and radiological features were retrospectively analyzed,and DSA presentations were summarized at 3,6,and 12 months after anticoagulant therapy.Results Nine patients all had diziness or vertigo,including five patients having inducement of acute neck activity and seven patients having occipital or posterior cervical pain.Most patients manifested cerebellum or brainstem infarction or Wallenberg syndrome in MRI.All patients had vertebral artery dissection (V3 segnent primarily),including five patients with string sign or rat tail sign,one patient with double cavity sign,two patients with vertebral occlusion and the last one patient with aneurysm expansion.Among 9 patients,the one with aneurysm expansion was directly treated with stent,the other 8 patients were treated with anticoagulant drug; DSA was performed at 3,6,and 12 months,and the rate of complete recanalization was 50％ (4/8) at 3 months,75％ (6/8) at 6 months and 75％(6/8) at 12 months; the patients without recanalization were then treated with stent.The average follow-up was 18 months without noting stroke recurrences.Conclusions Young stroke induced by vertebral artery dissection often merely manifests occipital or posterior cervical pain; cerebrovascular detection is very important to the diagnosis.Standard anticoagulant therapy can alleviate clinical symptoms and improve blood vessel status,and recanalization of vertebral artery dissection occurs mainly within the first 6 months of anticoagulant therapy.
Key words:
Vertebral artery dissection; Young stroke; Anticoagulant treatment
Vertebral artery dissection
Stroke
Back Pain
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Vertebral artery dissection
Occipital artery
Posterior cerebral artery
Digital subtraction angiography
Vertebrobasilar insufficiency
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Neuroradiology
Vertebral artery dissection
Cervical Artery
Arterial dissection
Vertebrobasilar insufficiency
Neurological deficit
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Citations (39)
Objective
To explore the imaging features of vertebral artery dissection evolving into vertebral dissecting aneurysm.
Methods
Analyzing the clinical data and image of one patient with the intracranial vertebral artery dissection evolving into vertebral dissecting aneurysm, and the relevant literatures were reviewed.
Results
During the headache, head computed tomography (CT) scan showed a possible arterial aneurysm at the end of basilar artery, the head magnetic resonance imaging (MRI) showed that there was a possible arterial aneurysm at the intersection of right vertebral artery and basilar artery.Furthermore, on the digital subtraction angiography (DSA) image, right vertebral artery had linear intima which meant right artery dissection.Seven months later, DSA image revealed an artery ectasia in right vertebral artery which was considered as the evolution from right vertebral dissection into aneurysm dissecting.
Conclusions
Even though the patient feel better, the risk of vertebral artery dissection evolving into dissecting aneurysm is high.Therefore, for patients with intracranial vertebral artery dissection, follow-up visit and reexamination are necessary.
Key words:
Headache; Vertebral artery dissection; Aneurysm, dissecting; Imaging features
Vertebral artery dissection
Ectasia
Digital subtraction angiography
Magnetic resonance angiography
Arterial dissection
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Citations (0)
We sought to identify the use of duplex and transcranial Doppler sonography in the noninvasive diagnosis of vertebral dissection. Ten patients with a diagnosis of symptomatic vertebral artery dissection confirmed by cerebral angiography were retrospectively analyzed. Computed tomographic scanning and magnetic resonance imaging together delineated lateral medullary or cerebellar infarcts in 7 patients. Angiography documented a total of 21 vertebral artery lesions (16 stenoses and 5 occlusions), with 7 of 10 patients having multiple sites of vertebral artery dissection. Vertebral Doppler was abnormal in 8 of the 10 patients. A high resistance signal in the relevant vertebral artery was found in 6 patients, no flow in a well-imaged vertebral artery in 1, and bilateral retrograde vertebral artery flow in 1 patient. Transcranial Doppler was abnormal in only 2 patients, with reduced pulsatility index in 1 and high resistance vertebral signal in another. A hyperintense intramural signal of the affected vertebral artery by magnetic resonance imaging was documented in 1 patient in whom Doppler sonography was nondiagnostic. Vertebral artery dissection can be detected and monitored by noninvasive vertebral Doppler and magnetic resonance imaging in the setting of a clinically suggestive presentation.
Vertebral artery dissection
Transcranial Doppler
Magnetic resonance angiography
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Citations (71)