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E-108 Endovascular treatment of patients with acute ischemic stroke due to underlying arterial dissection: a nationwide analysis
ConclusionsDespite a similar prevalence among patients admitted for AIS, CA dissections are associated with a higher rate of endovascular intervention and poorer short-term outcomes compared to VA dissections. This study provides essential epidemiologic and outcome data for the cerebrovascular neurosurgeon.Abstract E-108 Table 1Comparison of clinical characteristics and outcomes among patients presenting with acute ischemic stroke due to carotid or vertebral artery dissections Characteristic Vertebral Artery Dissection, N = 2,562 Carotid Artery Dissection, N = 2,789 p-value1 Age (years), Mean (SD) 53 (17) 57 (17) <0.00...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Brandel, M., McCann, C., Wali, A., Wu, V., Esmail, S., Steinberg, J., Olson, S., Pannell, J., Khalessi, A., Santiago-Dieppa, D. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

Vertebral Artery Dissection in Rheumatoid Arthritis with Cervical Spine Disease
A 59-year-old woman with long-standing active rheumatoid arthritis presented with posterior circulation ischemic stroke after vertebral dissection. She had severe multilevel degenerative changes of her cervical spine. She did not have classic stroke risk factors nor evidence of atherosclerotic disease or other systemic diseases. The most likely mechanism appears to be injury of the artery wall by an osteophyte, causing dissection that resulted in thrombosis and subsequent embolic strokes.
Source: Journal of Stroke and Cerebrovascular Diseases - January 25, 2013 Category: Neurology Authors: Ritika Mahajan, Branko N. Huisa Tags: Case Reports Source Type: research

The potential dangers of neck manipulation & risk for dissection and devastating stroke: An illustrative case & review of the literature.
The potential dangers of neck manipulation & risk for dissection and devastating stroke: An illustrative case & review of the literature. Biomed Res Rev. 2018;2(1): Authors: Turner RC, Lucke-Wold BP, Boo S, Rosen CL, Sedney CL Abstract Chiropractic cervical manipulation is a common practice utilized around the world. Most patients are never cleared medically for manipulation, which can be devastating for those few who are at increased risk for dissections. The high velocity thrust used in cervical manipulation can produce significant strain on carotid and vertebral vessels. Once a dissection h...
Source: Biomed Res - June 30, 2018 Category: Research Authors: Turner RC, Lucke-Wold BP, Boo S, Rosen CL, Sedney CL Tags: Biomed Res Rev Source Type: research

E-055 Internal carotid artery reconstruction with flow diverting stents in the treatment of acute ischemic stroke: technical considerations and medical management
ConclusionsFDS appear to be a safe and effective tool for reconstruction of a symptomatic dissection in tortuous cervical ICAs. Their flexibility allows conformation to complex anatomies and they can be traversed multiple times by aspiration catheters/stentrievers. We found excellent patency at follow up. The unique challenges posed by utilization of high-profile stents in acute stroke require appropriate technical execution and medical management.Disclosures E. Orru: None. F. Bounni: None. M. Marosfoi: None. N. Patel: None. A. Wakhloo: 1; C; Philips medical. 2; C; Stryker, Phenox. 4; C; InNeuroCo, EpiEP, Neural Analytics, ThrombX.
Source: Journal of NeuroInterventional Surgery - July 23, 2022 Category: Neurosurgery Authors: Orru, E., Bounni, F., Marosfoi, M., Patel, N., Wakhloo, A. Tags: SNIS 19th annual meeting electronic poster abstracts Source Type: research

A Serious Diagnosis Lacking Common Symptoms
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; & AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regi...
Source: The Case Files - May 28, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Results of carotid artery stenting with transcervical access
Conclusions: CAS with the transcervical approach is a safe procedure with low incidence of stroke and complications. It can be used as an alternative to femoral access in patients with unfavorable aortoiliac or aortic arch anatomy.
Source: Journal of Vascular Surgery - September 26, 2013 Category: Surgery Authors: George S. Sfyroeras, Konstantinos G. Moulakakis, Fotis Markatis, Constantinos N. Antonopoulos, George A. Antoniou, John D. Kakisis, Elias N. Brountzos, Christos D. Liapis Tags: Review article Source Type: research

The Case Files: Traumatic Carotid Dissection
By Hsiao, Jonie MD   A 30-year-old man who was right-hand dominant presented 10 days after sustaining left-sided face and head trauma from a fall from a skateboard at an unknown speed. He lost consciousness for several seconds, and initially developed a headache with nausea and vomiting. A non-contrast head CT performed at another hospital done two days after the incident was reportedly negative.   He now presents primarily with concerns about the appearance of his left eye. He has notable anisocoria and a droopy eyelid. His left pupil is notably smaller, 2 mm, compared with the right eye, 5 mm. Both are reactive. The re...
Source: The Case Files - June 4, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Comment CADISS: a feasibility trial that answered its question
Anticoagulation after ischaemic stroke was a topic of major controversy for decades until a series of randomised clinical trials consistently showed no net benefit of heparin or warfarin compared with aspirin.1,2 Any reduction in the risk of recurrent ischaemic stroke was offset by an increase in risk of intracerebral haemorrhages. One cause of stroke for which the effect of anticoagulation remains unclear is cervical artery dissection. The classic dogma was that a tear in the intima leads to formation of a fibrin-rich thrombus and poses a very high risk of artery-to-artery embolism or occlusion, making early anticoagulati...
Source: Lancet Neurology - February 12, 2015 Category: Neurology Authors: Scott E Kasner Tags: Comment Source Type: research

A Case Report of Locked-in Syndrome Due to Bilateral Vertebral Artery Dissection After Cervical Spine Manipulation Treated by Arterial Embolectomy
Abstract: Cervical spine manipulation (CSM) is a commonly spinal manipulative therapies for the relief of cervical spine-related conditions worldwide, but its use remains controversial. CSM may carry the potential for serious neurovascular complications, primarily due to vertebral artery dissection (VAD) and subsequent vertebrobasilar stroke. Here, we reported a rare case of locked-in syndrome (LIS) due to bilaterial VAD after CSM treated by arterial embolectomy. A 36-year-old right-handed man was admitted to our hospital with numbness and weakness of limbs after treating with CSM for neck for half an hour. Gradually, alt...
Source: Medicine - February 1, 2016 Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

A systematic review and meta-analysis of carotid artery stenting for the treatment of cervical carotid artery dissection
CONCLUSION: Both primary stenting and stenting of spontaneous CAD yielded unfavorable results regarding stent thrombosis and stroke rates. Conversely, stenting following FMT displayed acceptable mortality and complication rates corroborating the use of stenting in the setting of CAD as a second line treatment. Due to the low quality of the included studies, definite conclusions cannot be drawn necessitating further research.PMID:35961627 | DOI:10.1016/j.ejvs.2022.07.048
Source: PubMed: Eur J Vasc Endovasc ... - August 12, 2022 Category: Surgery Authors: Vangelis Bontinis Constantine N Antonopoulos Alkis Bontinis Andreas Koutsoumpelis Vassilios Zymvragoudakis Vasileios Rafailidis Argirios Giannopoulos Panagiotis Stoiloudis Kiriakos Ktenidis Source Type: research

Thunderclap headache: Diagnostic considerations and neuroimaging features
Thunderclap headache (TCH) is an acute and severe headache that has maximum intensity at onset; TCH can be primary or secondary. Primary TCH is diagnosed when no underlying cause is discovered; however, imaging is crucial in distinguishing secondary causes, which are wide-ranging. The radiologist should be aware of the list of potential diagnoses. Subarachnoid haemorrhage (SAH) is the most common cause of secondary TCH. Aneurysmal SAH accounts for the majority of cases, although other causes should also be considered and these include perimesencephalic haemorrhage, arteriovenous malformations, and dural arteriovenous fistu...
Source: Clinical Radiology - December 13, 2012 Category: Radiology Authors: A.M. Mortimer, M.D. Bradley, N.G. Stoodley, S.A. Renowden Tags: Reviews Source Type: research

Cervical Arterial Injury After Strangulation-Different Types of Arterial Lesions.
We report three unusual cases where strangulation induced immediate stroke. CAI were examined using brain CT scan and Doppler ultrasonography in the three cases and then by autopsy in one of the victims. One of the two victims who survived the attempted strangulation had a unilateral carotid dissection, whereas in the other victim, no arterial dissection or thrombosis was observed. As regards the deceased victim, the autopsy confirmed the bilateral dissection showed on CT scan and Doppler ultrasonic examination and revealed that both carotid arteries were dilated up to two times the normal diameter. Microscopic examination...
Source: Journal of Forensic Sciences - July 18, 2013 Category: Forensic Medicine Authors: Le Blanc-Louvry I, Papin F, Vaz E, Proust B Tags: J Forensic Sci Source Type: research

Neonatal cervical artery dissection secondary to birth trauma.
We report a case of a male newborn who was born vaginally after shoulder dystocia. The extraction was difficult, resulting in a fracture of the right humerus. On the second day of life, the child presented generalized clonic convulsions. Computed tomography of the brain showed an ischemic stroke in the territory of the right middle cerebral artery, the territory of the right posterior cerebral artery, and the right lenticulostriate and capsular regions. Doppler ultrasonography and magnetic resonance angiography showed bilateral carotid artery thrombosis and dissection at the left common carotid artery and its two branches ...
Source: Archives de Pediatrie - November 26, 2013 Category: Pediatrics Authors: Hamida N, Hakim A, Fourati H, Ben Thabet A, Walha L, Bouraoui A, Mnif Z, Gargouri A Tags: Arch Pediatr Source Type: research

Literature Review and Case Report of Intravenous Thrombolysis in Acute Cerebral Infarction Attributed to Cervical Arterial Dissection
Acute cerebral infarction (ACI) caused by cervical arterial dissection (CAD) is a rare clinical disease. Therapeutic approaches include anticoagulant therapy, antiplatelet aggregation, and thrombolytic therapy. Currently, anticoagulant therapy or antiplatelet aggregation is the primary choice, whereas the thrombolytic therapy is still controversial. In this article, we report a patient with ACI caused by right CAD, which led to a compensatory increase in blood supply to the right middle cerebral artery through the anterior communicating artery.
Source: Journal of Stroke and Cerebrovascular Diseases - July 8, 2015 Category: Neurology Authors: Zhihui Yan, Tianxia Yu, Ying Wang, Min Wang, Hui Liang Tags: Case Report Source Type: research

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