REVIEW

Carotid and vertebral artery dissection syndromes

B Thanvi¹, S K Munshi², S L Dawson², T G Robinson³

¹ Department of Integrated Medicine, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
² Department of Stroke Medicine, Leicester General Hospital
³ Leicester Warwick Medical School, Leicester General Hospital

Correspondence to:
Correspondence to:
Dr B Thanvi
Department of Integrated Medicine, Leicester General Hospital, Gwendolen Road, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK; bthanvi{at}hotmail.com

Cervicocerebral arterial dissections (CAD) are an important cause of strokes in younger patients accounting for nearly 20% of strokes in patients under the age of 45 years. Extracranial internal carotid artery dissections comprise 70%–80% and extracranial vertebral dissections account for about 15% of all CAD. Aetiopathogenesis of CAD is incompletely understood, though trauma, respiratory infections, and underlying arteriopathy are considered important. A typical picture of local pain, headache, and ipsilateral Horner’s syndrome followed after several hours by cerebral or retinal ischaemia is rare. Doppler ultrasound, MRI/MRA, and CT angiography are useful non-invasive diagnostic tests. The treatment of extracranial CAD is mainly medical using anticoagulants or antiplatelet agents although controlled studies to show their effectiveness are lacking. The prognosis of extracranial CAD is generally much better than that of the intracranial CAD. Recurrences are rare in CAD.

Abbreviations: CAD, cervicocerbral arterial dissection; ICD, internal carotid dissection; VAD, vertebral artery dissection; EICD, extracranial internal carotid artery dissection

Keywords: dissection; internal carotid artery; vertebral artery

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