engleski

Dissections of craniocervical arteries and vascular risk factors

Cervical artery dissection (CAD) can occur at any age, but is considered one of the most common causes of stroke in young adults. There is an association between migraine and stroke. Several small to medium sized studies indicated a link between CAD and migraine. AIM: To assess the incidence of vascular risk factors in consecutive patients with CAD. During one year 20 consecutive patients (18/20 <40 years old) were diagnosed with CAD. Neurosnology findings of dissection were separated into direct and indirect signs. Direct signs were: eholucent hematoma/string sign (35%), double lumen present (10%) and stenosis and/or occlusion of an arterial segment usually not affected by atherosclerosis(55%). Indirect signs were : increased or decreased pulsatility index (PI) upstream or downstream of the suspected lesion(40%), >50% difference in blood flow velocity (BFV) compared to the unaffected side(60%) and intracranial collateral flow(35%).Head and neck MR, MRA or CTA confirmed the diagnosis.Multivessel involvement was present in 4 patients, affection of one carotid artery in 9 and one vertebral artery in 7 patients. Hyperlipidemia was present in 11, arterial hypertension and migraine in 7, diabetes mellitus in 3, heart disease in 4 and smoking in 2 patients.Head or neck pain was the dominant symptom in 19/20 patients, followed by ischemic symptomatology in 17/20 (15 patients presented with ischemic stroke and 2 had TIA ), only one patient had intracranial hemorrhage. Follow up during one year showed recanalization rate: 10/20, while recurrence rate was 0/2 Conclusion: In this cohort of patients with CAD hyperlipidemia and arterial hypertension apper to be the most common risk factors, followed by heart disease and diabetes. Also, the migraine was present more common than in general population.

carotid artery dissection; vertebral artery dissection; vascular risk factors; stroke; neurosonology

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