Cervical dissection in emergency neurology: diagnostic and treatment algorithms
https://doi.org/10.30629/2658-7947-2022-27-4-86-96
Abstract
The epidemiology of cervical artery dissection (CAD), which is often not thought to be the cause of ischemic stroke and transient ischemic attack (TIA), is discussed. The pathomorphology and pathogenesis of CAD, the key feature of which is the development of intramural hematoma, as well as predisposing conditions, triggers and associated conditions, in particular migraine, are reviewed. The clinical picture of diseases — local symptoms (headache and/ or neck pain, Horner’s syndrome, caudal cranial nerve involvement, cervical radicular syndrome, pulsatile tinnitus) and ischemic events (ischemic stroke or TIA) is presented. Modern approaches to urgent neuro- and angioimaging in CAD are reflected, including the possibilities of CT angiography (direct and indirect signs) and fat sat MRI (crescent symptom). Issues of reperfusion therapy (intravenous thrombolysis, thrombectomy and stenting) are discussed. The course of disease and secondary antithrombotic prophylaxis are analyzed.
About the Authors
A. A. Kulesh
Wagner Perm State Medical University
Russian Federation
Russian Federation
Perm
D. A. Demin
Federal Central of Vascular Surgery
Russian Federation
Russian Federation
Astrakhan
O. I. Vinogradov
Pirogov National Medical and Surgical Center
Russian Federation
Russian Federation
Moscow
References
1. Debette S., Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 2009;8(7):668–78. https://doi.org/10.1016/S1474-4422(09)70084-5
2. Debette S. Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts? Curr Opin Neurol. 2014;27(1):20–8. https://doi.org/10.1097/WCO.0000000000000056
3. Engelter S.T., Traenka C., Lyrer P. Dissection of Cervical and Cerebral Arteries. Curr Neurol Neurosci Rep. 2017;17(8):59. https://doi.org/10.1007/s11910-017-0769-3
4. Traenka C., Dougoud D., Simonetti B.G., Metso T.M., Debette S., Pezzini A. et al. CADISP-Plus Study Group. Cervical artery dissection in patients ≥ 60 years: Often painless, few mechanical triggers. Neurology. 2017;88(14):1313–1320. https://doi.org/10.1212/WNL.0000000000003788
5. Atalay Y.B., Piran P., Chatterjee A., Murthy S., Navi B.B., Liberman A.L. et al. Prevalence of Cervical Artery Dissection Among Hospitalized Patients With Stroke by Age in a Nationally Representative Sample From the United States. Neurology. 2021;96(7):e1005–e1011. https://doi.org/10.1212/WNL.0000000000011420
6. Metso A.J., Metso T.M., Debette S., Dallongeville J., Lyrer P.A., Pezzini A. et al. CADISP Group. Gender and cervical artery dissection. Eur J Neurol. 2012;19(4):594–602. https://doi.org/10.1111/j.1468-1331.2011.03586.x
7. Riou-Comte N., Mione G., Humbertjean L., Ottenin M.A., Lacour J.C., Richard S. Spontaneous cervical artery dissection in patients aged over 70 years: two cases and systematic literature review. Clin Interv Aging. 2017;12:1355–1362. Published 2017 Aug 26. https://doi.org/10.2147/CIA.S138980
8. Lee V.H., Brown R.D. Jr., Mandrekar J.N., Mokri B. Incidence and outcome of cervical artery dissection: a populationbased study. Neurology. 2006;67(10):1809–12. https://doi.org/10.1212/01.wnl.0000244486.30455.71
9. Kalashnikova L.A., Gulevskaja T.S., Anufriev P.L., Konovalov R.N., Shhipakin A.O., Avdjunina I.A. et al. Lоwer cranial nerve palsiаs in the internаl carotid artery dissection. Annaly klinicheskoj i jeksperimental’noj nevrologii. 2008;2(1):22–27. (In Russ.).
10. Kalashnikova L.A. Dissection of internal carotid and vertebral arteries: clinical presentation, diagnosis, and treatment. Neurology, neuropsychiatry, psychosomatics. 2013;(S2):40–45. (In Russ.). https://doi.org/10.14412/2074-2711-2013-2357
11. Kalashnikova L.A., Dobrynina L.A., Dreval’ M.V., Doronina E.V., Nazarova M.A. Neck pain and headache as the only manifestation of cervical artery dissection. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2015;115(3):9–16. (In Russ.). https://doi.org/10.17116/jnevro2015115319-16
12. Kalashnikova L.A., Dobrynina L.A., Chechetkin A.O., Dreval’ M.V., Krotenkova M.V., Zaharkina M.V. Cerebral circulation disorders during dissection of the internal carotid and vertebral arteries. Diagnostic algorithm. Nervnye bolezni. 2016;2:10–15. (In Russ.).
13. Kalashnikova L.A., Dobrynina L.A., Maksimova M.Ju., Tanashjan M.M., Danilova M.S., Dreval’ M.V. Internal carotid and vertebral artery dissection: an approach to patient management. Annaly klinicheskoj i jeksperimental’noj nevrologii. 2021;15(1):5–12. (In Russ.). https://doi.org/10.25692/ACEN.2021.1.1
14. Kulesh A.A., Nurieva Yu.A., Syromyatnikova L.I. Causes of ischemic stroke in patients younger than 45 years: analysis of data from the regional vascular center. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(1):24–30. (In Russ.). https://doi.org/10.14412/2074-2711-2021-1-24-30
15. Debette S., Mazighi M., Bijlenga P., Pezzini A., Koga M., Bersano A. et al. ESO guideline for the management of extracranial and intracranial artery dissection. European Stroke Journal. 2021;6(3):XXXIX–LXXXVIII. https://doi.org/10.1177/23969873211046475
16. Engelter S.T., Lyrer P.,Traenka C. Cervical and intracranial artery dissections. Ther Adv Neurol Disord. 2021;14:17562864211037238. https://doi.org/10.1177/17562864211037238
17. Mehdi E., Aralasmak A., Toprak H., Yıldız S., Kurtcan S., Kolukisa M. et al. Craniocervical Dissections: Radiologic Findings, Pitfalls, Mimicking Diseases: A Pictorial Review. Curr Med Imaging Rev. 2018;14(2):207–222. https://doi.org/10.2174/1573405613666170403102235
18. Béjot Y., Aboa-Eboulé C., Debette S., Pezzini A., Tatlisumak T., Engelter S. et al. CADISP Group. Characteristics and outcomes of patients with multiple cervical artery dissection. Stroke. 2014;45(1):37–41. https://doi.org/10.1161/STROKEAHA.113.001654
19. Guglielmi V., Visser J., Arnold M., Sarikaya H., van den Berg R., Nederkoorn P.J. et al. Triple and quadruple cervical artery dissections: a systematic review of individual patient data. J Neurol. 2019;266(6):1383–1388. https://doi.org/10.1007/s00415-019-09269-1
20. Brandt T., Orberk E., Weber R., Werner I., Busse O., Müller B.T. et al. Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology. 2001;57(1):24–30. https://doi.org/10.1212/wnl.57.1.24
21. Engelter S.T., Grond-Ginsbach C., Metso T.M., Metso A.J., Kloss M., Debette S. et al. Cervical Artery Dissection and Ischemic Stroke Patients Study Group. Cervical artery dissection: trauma and other potential mechanical trigger events. Neurology. 2013;80(21):1950–7. https://doi.org/10.1212/WNL.0b013e318293e2eb
22. Engelter S.T., Traenka C., Grond-Ginsbach C., Brandt T., Hakimi M., Worrall B.B. et al. Cervical Artery Dissection and Sports. Front Neurol. 2021;12:663830. https://doi.org/10.3389/fneur.2021.663830
23. Strambo D., Sirimarco G., Inácio N., Eskandari A., Michel P. Skiing Associated Stroke: Causes, Treatment, and Outcome. J Stroke Cerebrovasc Dis. 2019;28(2):288–294. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.049
24. Baldino G., Di Girolamo C., De Blasis G., Gori A. Eagle Syndrome and Internal Carotid Artery Dissection: Description of Five Cases Treated in Two Italian Institutions and Review of the Literature. Ann Vasc Surg. 2020;67:565.e17 — 565.e24. https://doi.org/10.1016/j.avsg.2020.02.033
25. Hunter M.D., Moon Y.P., Miller E.C., Kulick E.R., Boehme A.K., Elkind M.S. Influenza-Like Illness is Associated with Increased Short-Term Risk of Cervical Artery Dissection. J Stroke Cerebrovasc Dis. 2021;30(2):105490. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105490
26. Metso T.M., Tatlisumak T., Debette S., Dallongeville J., Engelter S.T., Lyrer P.A. et al. CADISP group. Migraine in cervical artery dissection and ischemic stroke patients. Neurology. 2012;78(16):1221–8. https://doi.org/10.1212/WNL.0b013e318251595f
27. De Giuli V., Grassi M., Lodigiani C., Patella R., Zedde M., Gandolfo C. et al. Italian Project on Stroke in Young Adults Investigators. Association Between Migraine and Cervical Artery Dissection: The Italian Project on Stroke in Young Adults. JAMA Neurol. 2017;74(5):512–518. https://doi.org/10.1001/jamaneurol.2016.5704
28. West B.H., Noureddin N., Mamzhi Y., Low C.G., Coluzzi A.C., Shih E.J. et al. Frequency of Patent Foramen Ovale and Migraine in Patients With Cryptogenic Stroke. Stroke. 2018;49(5):1123–1128. https://doi.org/10.1161/STROKEAHA.117.020160
29. De Giuli V., Graziano F., Zini A., Zedde M., Patella R., Lodigiani C. et al. Italian Project on Stroke in Young Adults (IPSYS) Investigators. Migraine improvement after spontaneous cervical artery dissection the Italian Project on Stroke in Young Adults (IPSYS). Neurol Sci. 2019;40(1):59–66. https://doi.org/10.1007/s10072-018-3578-9
30. Morelli N., Rota E., Michieletti E., Guidetti D. Spontaneous cervical artery dissection and prevalence of right-to-left shunt. Neurology and Neurobiology. 2018;1(1):2–3; https://doi.org/10.10xx/j.NNB.2018.10.001
31. Béjot Y., Aboa-Eboulé C., Debette S., Pezzini A., Tatlisumak T., Engelter S.et al. CADISP Group. Characteristics and outcomes of patients with multiple cervical artery dissection. Stroke. 2014;45(1):37–41. https://doi.org/10.1161/STROKEAHA.113.001654
32. von Sarnowski B., Schminke U., Grittner U., Fazekas F., Tanislav C., Kaps M. et al. Cervical artery dissection in young adults in the stroke in young Fabry patients (sifap1) study. Cerebrovasc Dis. 2015;39(2):110–21. https://doi.org/10.1159/000371338
33. Mawet J., Boukobza M., Franc J., Sarov M., Arnold M., Bousser M.G., Ducros A. Reversible cerebral vasoconstriction syndrome and cervical artery dissection in 20 patients. Neurology. 2013;81(9):821–4. https://doi.org/10.1212/WNL.0b013e3182a2cbe2
34. Debette S., Grond-Ginsbach C., Bodenant M., Kloss M., Engelter S., Metso T. et al. Cervical Artery Dissection Ischemic Stroke Patients (CADISP) Group. Differential features of carotid and vertebral artery dissections: the CADISP study. Neurology. 2011;77(12):1174–81. https://doi.org/10.1212/WNL.0b013e31822f03fc
35. Vidale S. Headache in cervicocerebral artery dissection. Neurol Sci. 2020;41(Suppl.2):395–399. https://doi.org/10.1007/s10072-020-04651-8
36. Wang Y., Cheng W., Lian Y., Zhang J., Zheng Y., Hu Y. et al. Characteristics and relative factors of headache caused by cervicocerebral artery dissection. J Neurol. 2019;266(2):298–305. https://doi.org/10.1007/s00415-018-9111-5
37. Lyrer P.A., Brandt T., Metso T.M., Metso A.J., Kloss M., Debette S. et al. Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) Study Group. Clinical import of Horner syndrome in internal carotid and vertebral artery dissection. Neurology. 2014;82(18):1653–9. https://doi.org/10.1212/WNL.0000000000000381
38. Pokalenko E.A., Dultsev K.N., Kulesh A.A., Drobakha V.E., Karakulov O.G., Shestakov V.V. Carotid artery stenting in cervical dissection. Russian neurological journal. 2019;(4):23–30. (In Russ.). https://doi.org/10.18821/1560-9545-2019-24-1-42-48
39. Gottesman R.F., Sharma P., Robinson K.A., Arnan M., Tsui M., Ladha K., Newman-Toker D.E. Clinical characteristics of symptomatic vertebral artery dissection: a systematic review. Neurologist. 2012;18(5):245–54. https://doi.org/10.1097/NRL.0b013e31826754e1
40. Kulesh A.A., Dyomin D.A., Guseva A.L., Vinogradov O.I., Parfyonov V.A. Vestibular vertigo in emergency neurology. Russian neurological journal. 2021;26(4):50–59. (In Russ.). https://doi.org/10.30629/2658-7947-2021-26-4-50-59
41. Bond K.M., Krings T., Lanzino G., Brinjikji W. Intracranial dissections: A pictorial review of pathophysiology, imaging features, and natural history. J Neuroradiol. 2021;48(3):176–188. https://doi.org/10.1016/j.neurad.2020.03.007
42. Hakimi R., Sivakumar S. Imaging of Carotid Dissection. Curr Pain Headache Rep. 2019;23(1):2. https://doi.org/10.1007/s11916-019-0741-9
43. Engelter S.T., Rutgers M.P., Hatz F., Georgiadis D., Fluri F., Sekoranja L. et al. Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke. 2009;40(12):3772–6. https://doi.org/10.1161/STROKEAHA.109.555953
44. Engelter S.T., Dallongeville J., Kloss M., Metso T.M., Leys D., Brandt T. et al.; Cervical Artery Dissection and Ischaemic Stroke Patients-Study Group. Thrombolysis in cervical artery dissection-data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database. Eur J Neurol. 2012;19(9):1199–206. https://doi.org/10.1111/j.1468-1331.2012.03704.x
45. Tsivgoulis G., Zand R., Katsanos A.H., Sharma V.K., Goyal N., Krogias C. et al. Safety and outcomes of intravenous thrombolysis in dissection-related ischemic stroke: an international multicenter study and comprehensive meta-analysis of reported case series. J Neurol. 2015;262(9):2135–43. https://doi.org/10.1007/s00415-015-7829-x
46. Lin J., Sun Y., Zhao S., Xu J., Zhao C. Safety and Efficacy of Thrombolysis in Cervical Artery Dissection-Related Ischemic Stroke: A Meta-Analysis of Observational Studies. Cerebrovasc Dis. 2016;42(3–4):272–9. https://doi.org/10.1159/000446004
47. Bernardo F., Nannoni S., Strambo D., Bartolini B., Michel P., Sirimarco G. Intravenous thrombolysis in acute ischemic stroke due to intracranial artery dissection: a single-center case series and a review of literature. J Thromb Thrombolysis. 2019;48(4):679–684. https://doi.org/10.1007/s11239-019-01918-6
48. Traenka C., Jung S., Gralla J., Kurmann R., Stippich C., Simonetti B.G. et al. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke — Results from the SWISS registry. Eur Stroke J. 2018;3(1):47–56. https://doi.org/10.1177/2396987317748545
49. Schlemm L., von Rennenberg R., Siebert E., Bohner G., Flottmann F., Petzold G.C. et al. GSR-ET investigators. Mechanical thrombectomy in patients with cervical artery dissection and stroke in the anterior or posterior circulation — a multicenter analysis from the German Stroke Registry. Neurol Res Pract. 2021;3(1):20. https://doi.org/10.1186/s42466-021-00119-y
50. Karam A., Bricout N., Khyeng M., Cordonnier C., Leclerc X., Henon H., Casolla B. Safety and outcome of mechanical thrombectomy in ischaemic stroke related to carotid artery dissection. J Neurol. 2021;Jun29. https://doi.org/10.1007/s00415-021-10656-w
51. Marnat G., Sibon I., Bourcier R., Anadani M., Gariel F., Labreuche J. et al.; ETIS and TITAN Investigators. Thrombolysis Improves Reperfusion and the Clinical Outcome in Tandem Occlusion Stroke Related to Cervical Dissection: TITAN and ETIS Pooled Analysis. J Stroke. 2021;23(3):411–419. https://doi.org/10.5853/jos.2020.04889
52. Marnat G., Lapergue B., Sibon I., Gariel F., Bourcier R., Kyheng M. et al.; TITAN and ETIS Investigators*. Safety and Outcome of Carotid Dissection Stenting During the Treatment of Tandem Occlusions: A Pooled Analysis of TITAN and ETIS. Stroke. 2020;51(12):3713–3718. https://doi.org/10.1161/STROKEAHA.120.030038
53. Pinho J., Rocha S., Varanda S., Ribeiro M., Rocha J., Ferreira C. Cerebral hyperperfusion syndrome: a novel presentation of internal carotid artery dissection. Neurology. 2013;81(6):599–601. https://doi.org/10.1212/WNL.0b013e31829e6f26
54. Judy B.F., Theodore N. Bow Hunter’s Syndrome. World Neurosurg. 2021;148:127–128. https://doi.org/10.1016/j.wneu.2021.01.030
55. Morris N.A., Merkler A.E., Gialdini G., Kamel H. Timing of Incident Stroke Risk After Cervical Artery Dissection Presenting Without Ischemia. Stroke. 2017;48(3):551–555. https://doi.org/10.1161/STROKEAHA.116.015185 Erratum in: Stroke. 2018;49(10):e308.
56. Gensicke H., Ahlhelm F., Jung S., von Hessling A., Traenka C., Goeggel Simonetti B. et al. New ischaemic brain lesions in cervical artery dissection stratified to antiplatelets or anticoagulants. Eur J Neurol. 2015;22(5):859–65,e61. https://doi.org/10.1111/ene.12682
57. Kloss M., Grond-Ginsbach C., Ringleb P., Hausser I., Hacke W., Brandt T. Recurrence of cervical artery dissection: An underestimated risk. Neurology. 2018;90(16):e1372–e1378. https://doi.org/10.1212/WNL.0000000000005324
58. Kloss M., Kalashnikova L., Dobrynina L., Traenka C., Engelter S.T., Metso T.M. et al. Recurrent versus first cervical artery dissection — a retrospective study of clinical and vascular characteristics. Eur J Neurol. 2020;27(11):2185–2190. https://doi.org/10.1111/ene.14417
59. Traenka C., Grond-Ginsbach C., Goeggel Simonetti B., Metso T.M., Debette S., Pezzini A. et al.; CADISP-Plus Study Group. Artery occlusion independently predicts unfavorable outcome in cervical artery dissection. Neurology. 2020;94(2):e170–e180. https://doi.org/10.1212/WNL.0000000000008654
60. Perry B.C., Al-Ali F. Spontaneous cervical artery dissection: the borgess classification. Front Neurol. 2013;4:133. https://doi.org/10.3389/fneur.2013.00133
61. CADISS trial investigators, Markus H.S., Hayter E., Levi C., Feldman A., Venables G., Norris J. Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol. 2015;14(4):361–7. https://doi.org/10.1016/S1474-4422(15)70018-9
62. Markus H.S., Levi C., King A., Madigan J., Norris J.; Cervical Artery Dissection in Stroke Study (CADISS) Investigators. Antiplatelet Therapy vs Anticoagulation Therapy in Cervical Artery Dissection: The Cervical Artery Dissection in Stroke Study (CADISS) Randomized Clinical Trial Final Results. JAMA Neurol. 2019;76(6):657–664. https://doi.org/10.1001/jamaneurol.2019.0072
63. Engelter S.T., Traenka C., Gensicke H., Schaedelin S.A., Luft A.R., Simonetti B.G. et al.; TREAT-CAD investigators. Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial. Lancet Neurol. 2021;20(5):341–350. https://doi.org/10.1016/S1474-4422(21)00044-2
64. Caprio F.Z., Bernstein R.A., Alberts M.J., Curran Y., Bergman D., Korutz A.W. et al. Efficacy and safety of novel oral anticoagulants in patients with cervical artery dissections. Cerebrovasc Dis. 2014;38(4):247–53. https://doi.org/10.1159/000366265
65. Kleindorfer D.O., Towfighi A., Chaturvedi S., Cockroft K.M., Gutierrez J., Lombardi-Hill D. et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/ American Stroke Association. Stroke. 2021;52(7):e364–e467. https://doi.org/10.1161/STR.0000000000000375
66. Ahmed N., Steiner T., Caso V., Wahlgren N.; ESO-KSU session participants. Recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 13–15 November 2016. Eur Stroke J. 2017;2(2):95–102. https://doi.org/10.1177/2396987317699144
67. Patel S.D., Haynes R., Staff I., Tunguturi A., Elmoursi S., Nouh A. Recanalization of cervicocephalic artery dissection. Brain Circ. 2020;6(3):175–180. https://doi.org/10.4103/bc.bc_19_20
Review
For citations:
Kulesh A.A., Demin D.A., Vinogradov O.I. Cervical dissection in emergency neurology: diagnostic and treatment algorithms. Russian neurological journal. 2022;27(4):86-96. (In Russ.) https://doi.org/10.30629/2658-7947-2022-27-4-86-96
Views:
792
Email this article 