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Anemia in young patients with ischaemic stroke
ConclusionAnemia on admission was associated with stroke in CeAD patients and with more severe strokes in both study samples. Moderate to severe anemia may predict unfavorable outcome.
Source: European Journal of Neurology - February 24, 2015 Category: Neurology Authors: L. Kellert, M. Kloss, A. Pezzini, T. M. Metso, A. J. Metso, S. Debette, D. Leys, V. Caso, V. Thijs, A. Bersano, E. Touzé, T. Tatlisumak, H. Gensicke, P. A. Lyrer, J. Bösel, S. T. Engelter, C. Grond‐Ginsbach, Tags: Original Article Source Type: research

Response to Cassidy and Cote
We thank Drs Cassidy and Cote for their letter in response to our article “Case Misclassification….” It appears as if the methods and impact of our study was misinterpreted and we appreciate the opportunity to offer clarification. Our primary aim was very simple—to determine the positive predictive value (PPV) for identifying cervical artery dissection (CAD) by using the search strategy used in the studies by Rothwell and Cassidy. The earlier studies purport to negate the causal association between cervical manipulative therapy (CMT) and CAD by demonstrating a similar association between visits to primary care phys...
Source: Journal of Stroke and Cerebrovascular Diseases - February 24, 2015 Category: Neurology Authors: David E. Thaler Tags: Letter to the Editor Source Type: research

CADISS: Antiplatelet, Anticoagulant Equal in Cervical DissectionCADISS: Antiplatelet, Anticoagulant Equal in Cervical Dissection
The first randomized comparison of antiplatelet vs anticoagulant therapy for cervical artery dissection finds no difference in recurrent stroke, although event rates were very low. Medscape Medical News
Source: Medscape Neurology and Neurosurgery Headlines - February 17, 2015 Category: Neurology Tags: Neurology & Neurosurgery News Source Type: news

Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial
Publication date: Available online 12 February 2015 Source:The Lancet Neurology Background Extracranial carotid and vertebral artery dissection is an important cause of stroke, especially in young people. In some observational studies it has been associated with a high risk of recurrent stroke. Both antiplatelet drugs and anticoagulant drugs are used to reduce risk of stroke but whether one treatment strategy is more effective than the other is unknown. We compared their efficacy in the Cervical Artery Dissection in Stroke Study (CADISS), with the additional aim of establishing the true risk of recurrent stroke. Methods W...
Source: The Lancet Neurology - February 13, 2015 Category: Neurology 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

Articles Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial
We found no difference in efficacy of antiplatelet and anticoagulant drugs at preventing stroke and death in patients with symptomatic carotid and vertebral artery dissection but stroke was rare in both groups, and much rarer than reported in some observational studies. Diagnosis of dissection was not confirmed after review in many cases, suggesting that radiographic criteria are not always correctly applied in routine clinical practice.
Source: Lancet Neurology - February 12, 2015 Category: Neurology Authors: The CADISS trial investigators Tags: Articles Source Type: research

Spontaneous dissection of the bilateral internal carotid and vertebral arteries: A rationale for endovascular management
Spontaneous cervical-artery-dissection (sCAD) is a common cause of stroke in young patients. The incidence of concurrent sCAD of more than one neck artery ranges between 10 and 28% [1]. Multi-vessel sCAD is associated with a higher risk of intracranial hemorrhage as well as a higher risk of recurrent stroke or TIA [1]. Postpartum CAD accounts for 6% of spontaneous CAD in women under 50years of age [2]. Medical management is the primary treatment approach, while the role of endovascular intervention remains unclear.
Source: Journal of the Neurological Sciences - February 9, 2015 Category: Neurology Authors: Nitin Goyal, Shailesh Male, Vinodh T. Doss, Adam Arthur, Lucas Elijovich Tags: Letter to the Editor Source Type: research

Cervical Artery Dissection in Young Adults in the Stroke in Young Fabry Patients (sifap1) Study
Background: Patients with carotid artery dissection (CAD) have been reported to have different vascular risk factor profiles and clinical outcomes to those with vertebral artery dissection (VAD). However, there are limited data from recent, large international studies comparing risk factors and clinical features in patients with cervical artery dissection (CeAD) with other TIA or ischemic stroke (IS) patients of similar age and sex. Methods: We analysed demographic, clinical and risk factor profiles in TIA and IS patients ≤55 years of age with and without CeAD in the large European, multi-centre, Stroke In young FAbry Pa...
Source: Cerebrovascular Diseases - January 23, 2015 Category: Neurology Source Type: research

Risk of recurrent cervical artery dissection during pregnancy, childbirth and puerperium
ConclusionsOur observation suggests that the risk of recurrent CAD may not be greatly increased with pregnancies starting at least 12 months after CAD in women without typical connective tissue disease.
Source: European Journal of Neurology - November 29, 2014 Category: Neurology Authors: M. Reinhard, M. Munz, A.‐L. Kannen, H.‐J. Griesser‐Leute, R. Dittrich, S. T. Engelter Tags: Short Communication Source Type: research

Familial occurrence and heritable connective tissue disorders in cervical artery dissection
Conclusions: In this largest series of patients with CeAD to date, family history of symptomatic CeAD was rare and inherited connective tissue disorders seemed exceptional. This finding supports the notion that CeAD is a multifactorial disease in the vast majority of cases.
Source: Neurology - November 24, 2014 Category: Neurology Authors: Debette, S., Goeggel Simonetti, B., Schilling, S., Martin, J. J., Kloss, M., Sarikaya, H., Hausser, I., Engelter, S., Metso, T. M., Pezzini, A., Thijs, V., Touze, E., Paolucci, S., Costa, P., Sessa, M., Samson, Y., Bejot, Y., Altintas, A., Metso, A. J., H Tags: Stroke in young adults, All Cerebrovascular disease/Stroke, Carotid artery dissection, Risk factors in epidemiology, All Genetics ARTICLE Source Type: research

Connective tissue anomalies in patients with spontaneous cervical artery dissection
Conclusions: Connective tissue abnormalities are frequent in patients with sCeAD. This reinforces the hypothesis that systemic aberrations of the connective tissue might be implicated in the pathogenesis of the disease.
Source: Neurology - November 24, 2014 Category: Neurology Authors: Giossi, A., Ritelli, M., Costa, P., Morotti, A., Poli, L., Del Zotto, E., Volonghi, I., Chiarelli, N., Gamba, M., Bovi, P., Tomelleri, G., Carletti, M., Checcarelli, N., Meneghetti, G., Morra, M., Chinaglia, M., De Giuli, V., Colombi, M., Padovani, A., Pe Tags: Stroke in young adults, Carotid artery dissection, Risk factors in epidemiology ARTICLE Source Type: research

Efficacy and Safety of Novel Oral Anticoagulants in Patients with Cervical Artery Dissections
We report on the use, safety, and efficacy of NOACs in the treatment of CAD. Methods: We retrospectively identified patients diagnosed with CAD at a single academic center between January 2010 and August 2013. Patients were categorized by their antithrombotic treatment at hospital discharge with a NOAC (dabigatran, rivaroxaban, or apixaban), traditional anticoagulant (AC: warfarin or treatment dose low-molecular weight heparin), or antiplatelet agent (AP: aspirin, clopidogrel, or aspirin/extended-release dypyridamole). Using appropriate tests, we compared the baseline medical history, presenting clinical symptoms and initi...
Source: Cerebrovascular Diseases - November 12, 2014 Category: Neurology Source Type: research

Combined thrombolysis in posterior circulation stroke caused by bilateral vertebral artery dissection in squash player.
CONCLUSIONS: Vertebral artery dissection should be taken into consideration in differential diagnosis of posterior circulation stroke or TIA in young patients with a history of even as subtle precipitating events as forceful head movements. Combined thrombolytic therapy may provide safe and effective treatment of stroke-complicated cases. This case report shows that expanded diagnostic protocol for acute ischemic stroke, including computed tomography perfusion study and angiography of cervical and cranial vessels, assures rapid and correct diagnosis. PMID: 25168332 [PubMed - indexed for MEDLINE]
Source: Neurologia i Neurochirurgia Polska - October 26, 2014 Category: Neurology Authors: Frankowska E, Brzozowski K, Staszewski J, Kolmaga N, Stępień A, Bogusławska-Walecka R Tags: Neurol Neurochir Pol Source Type: research

Posterior circulation ischemic stroke with aberrant vertebral artery cervical entrance at the C4 vertebral level
We describe 2 cases of recurrent ischemic stroke in the posterior circulation associated with an abnormal vertebral artery (VA) entrance into the transverse foramen. Neither patient had evidence of atherosclerotic disease, but both had arterial wall defects nearby the VA entrance at the C4 level suggestive of local arterial dissection.
Source: Nature Clinical Practice - October 13, 2014 Category: Neurology Authors: Huisa, B. N., Mathes, L. M. Tags: CT, MRI, Other cerebrovascular disease/ Stroke, All Clinical Neurology, All Cerebrovascular disease/Stroke Cases Source Type: research

Spontaneous cervical internal carotid artery vasospasm: Case report and literature review
We report a case of recurrent TIA caused by alternating cervical ICA spasms. We also performed a MEDLINE search of previous publications in English from 1950 to August 2013. The search was performed with both text word searching and the appropriate MeSH headings of "carotid vasospasm" and "stroke," "cerebrovascular accident," "TIA," or "brain attack." The bibliographies of each of the retrieved articles with similar cases were all reviewed and relevant citations in these listings were evaluated for inclusion in the review.
Source: Nature Clinical Practice - October 13, 2014 Category: Neurology Authors: Huisa, B. N., Roy, G. Tags: Magnetic Source Imaging (MSI), Other cerebrovascular disease/ Stroke, Carotid artery dissection Cases Source Type: research

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