Postgrad Med J 81:383-388 doi:10.1136/pgmj.2003.016774
  • Review

Carotid and vertebral artery dissection syndromes

  1. B Thanvi1,
  2. S K Munshi2,
  3. S L Dawson2,
  4. T G Robinson3
  1. 1Department of Integrated Medicine, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
  2. 2Department of Stroke Medicine, Leicester General Hospital
  3. 3Leicester Warwick Medical School, Leicester General Hospital
  1. Correspondence to:
 Dr B Thanvi
 Department of Integrated Medicine, Leicester General Hospital, Gwendolen Road, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK;
  • Received 6 November 2003
  • Accepted 31 August 2004


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.


  • Funding: none.

  • Conflicts of interest: none declared.