engleski

Dissection of craniocervical arteries

Dissections of craniocervical arteries (carotid and vertebral) are acute disruption of the arterial wall. They are a relatively infrequent cause of stroke in the general population, but are a more common cause of stroke in younger patients, especially women. In most cases, their cause and pathogenesis are not clear. Dissections are generally divided into two groups, spontaneous and traumatic. Dissections may occasionally affect multiple vessels. The study included eight patients, four men and four women, aged 41-66 years, with dissection of a carotid or vertebral artery. Clinical presentation, ultrasonographic (US) examination (transcranial color Doppler and color-coded duplex sonography of the carotid and vertebral arteries), and neuroimaging (computed tomography and digital subtraction angiography) were observed. Spontaneous dissections were diagnosed in six, and posttraumatic in two patients. Common clinical manifestations included headache, pain in the neck, and signs of focal neurologic symptoms prevailed. Hypertension was present in seven, increased blood lipids in three, and diabetes mellitus in two patients. Dissection of internal carotid artery was found in five and of vertebral artery in two patients, whereas one patient had ipsilateral dissection of the carotid and vertebral artery. One of the patients with internal carotid artery dissection also had an intracranial aneurysm. Two patients were operatively treated five with anticoagulation therapy, and one with antithrombotic therapy. During posttherapeutic follow-up, six patients had partial clinical recovery and improvement o'f US findings in the dissected arteries. One patient suffered a stroke after the operation, with exacerbation of the neurologic deficit. In one patient, treated with antithrombotic therapy only, fatal stroke recurred after 3 months. Earliest possible clinical recognition, and non-invasive US and radiologic detection of craniocerebral artery dissection are of paramount importance. Anticoagulation therapy should be immediately introduced to minimize morbidity and mortality due to this condition

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