Spontaneous Dissections of the Vertebral Arteries and the Carotid Arteries have Different Clinical Presentations and Outcomes
By Matthew E. Fink, MD, Professor and Chairman, Department of Neurology, Weill Cornell Medical College, and Neurologist-in-Chief, New York Presbyterian Hospital. Dr. Fink is a retained consultant for MAQUET. The article originally appeared in the July 2013 issue of Neurology Alert.
Source: von Babo M, et al. Differences and similarities between spontaneous dissections of the internal carotid artery and the vertebral artery. Stroke 2013;44:1537-1542.
The authors compared potential risk factors, clini-cal symptoms, diagnostic delay, and 3-month outcome between spontaneous internal carotid artery dissection (sICAD) and spontaneous vertebral artery dissection (sVAD). There were 668 patients with sICAD and 302 patients with sVAD from three university hospitals. Patients with sICAD were older (43.3 vs 42.0, P < 0.001), more often men (62.7% vs 53%, P = 0.004), and presented more often with tinnitus (10.9% vs 3.4%, P < 0.001), and they had more severe ischemic strokes (NIHSS 10 vs 5, P < 0.001). Patients with sVAD more often had bilateral dissections (15.2% vs 7.6%, P < 0.001) and were more often smokers (36% vs 28%, P = 0.007). Thunderclap headache (9.2 % vs 3.6%, P = 0.001) and neck pain were more common (65.5% vs 33.5%, P < 0.001) in sVAD. Time to diagnosis was similar in both groups and improved between 2001 and 2012 compared to the previous 10-year period. In sVAD, favorable outcome 3 months after ischemic stroke (mRS, 0-2: 88.8% vs 58.4%, P < 0.001), recurrent transient ischemic attack (4.8% vs 1.1%, P = 0.001), and recurrent ischemic stroke (2.8% vs 0.7%, P = 0.02) within 3 months were more frequent. The clinical presentations of these dissections are quite different and suggest different etiologies for the disorders.