Fact-sheet: Dissection of cervicocephalic arteries
Updated on 08/25/2020 at 5:12 PM
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Definition
Occurrence of a wall hematoma of the arteries supplying the brain.
Etiologies are often spontaneous, also associated with cervical trauma.
This is a frequent cause of ischemic stroke in young patients.
Other etiologies: hypertension, Marfan syndrome, Ehlers-Danlos syndrome
Clinical features
- Neck pain
- Headache, occasionally thunderclap in onset.
- Neurological signs (focal deficit or Claude Bernard-Horner syndrome, cranial nerve involvement)
CT
CT angiography:
- Increased external diameter of the artery
- Decreased internal diameter of the artery
- Hematoma of the arterial wall
- Crescent-shaped mural thickening
Preferential locations:
middle third and subpetrous segment of the internal carotid artery; vertebral arteries at the C2, C3, C4 level
MRI
- Fat-saturated T1: hyperintense mural
hematoma. - MR angiography: useful for diagnosis and follow-up to determine whether anticoagulant therapy can be discontinued. Signal void
- Disparity and irregularity of vessel caliber
- Occlusive, stenotic, or aneurysmal form
- Evaluation of the brain parenchyma to look for signs of cerebral infarction.
Vascular intervention
- Recanalization to be considered in cases of stroke
Management
- Anticoagulation
- Follow-up and course: complete resolution
- Arterial thrombosis
- Dissecting aneurysm
