Cervical artery dissection

3 Interesting Facts of Cervical artery dissection

  1. Cervical artery dissection is a major cause of ischemic stroke in young adults, often precipitated by trauma, neck hyperextension, or neck rotation
  2. Cervical artery (carotid or vertebral) dissections result either from an intimal tear or from direct bleeding within the arterial wall due to ruptured vasa vasorum
    • Internal carotid artery dissections present with a classic triad: ipsilateral headache, partial Horner syndrome, and ischemic symptoms (ie, transient ischemic attack, transient monocular blindness, ischemic stroke)
    • Vertebral artery dissections are associated with posterior neck pain and posterior cerebral or brainstem ischemia
  3. Arterial dissection is differentiated from moyamoya arteriopathy based on imaging study findings 
    • On MRI, dissection is seen as a hyperintense, crescent-shaped wall hematoma and an eccentric flow void of the patent lumen
    • On magnetic resonance angiography, axial T1 images through the vessel lumen may show a crescent sign (ie, elliptical bright signal within a vessel wall that surrounds a signal flow void) 
    • On digital subtraction angiography, dissection is seen as a string sign (ie, a smooth tapered luminal narrowing), an intimal flap, or double-barrel lumen
    • Characteristic puff of smoke appearance of moyamoya is not seen in arterial dissections
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