Abstract
Background
Cervical artery dissection (CAD) is a common cause of ischemic stroke in the younger age group. Modern imaging techniques allow the depiction of the mural hematoma, even in CADs with only subtle vessel alterations. The aim of this retrospective study was (1) to characterize the angiological features in CAD and (2) to determine the frequency of initially normal ultrasonography (US) findings.
Methods
86 patients aged 44 ± 11 years with CAD of the internal carotid (ICA), (n = 55) or the vertebral artery (VA), (n = 31), admitted to our hospital within 8 days (mean 1.6 days) of symptom onset, were included. CAD was confirmed either by CT–angiography, MRI of the neck, MR–angiography or digital substraction angiography (DSA) and was compared with the results of the initial as well as repeated US examinations of the arteries supplying the brain.
Results
In 75 patients (81.2 %) signs of vessel stenosis or occlusion were found while 11 patients (12.8%) with CAD of the ICA (n = 9) and the VA (n = 2) had normal US findings. The site of dissection in the US negative patients was highly variable without a predilection site. In 2 of 7 patients with repeated US examinations, complete vessel occlusion was found on follow–up, while in 5 patients again normal results were found. In four patients, there were changing findings in two alternative confirming imaging methods (MRI/DSA, CT/MRI) and in one patient conflicting findings (CT/MRI). Brain infarctions had occurred in 7 of the initially sonographically normal patients while the other 4 had suffered from transient (n = 2) or local (n = 2) symptoms only.
Conclusion
Approximately 1 out of 8 patients with subsequently proven CAD has negative initial neurovascular US findings despite comprehensive examination. In patients with suspected CAD and negative US examination, repeated US examinations and further diagnostic imaging, especially MRI is necessary.
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References
Giroud M, Fayolle H, Andre N, Dumas R, Becker F, Martin D, Baudoin N, Krause D (1994) Incidence of internal carotid artery dissection in the community of Dijon. J Neurol Neurosurg Psychiatry 57:1443
Schievink WI, Mokri B, Whisnant JP (1993) Internal carotid artery dissection in a community. Rochester, Minnesota, 1987–1992. Stroke 24:1678–1680
Schievink WI, Mokri B, O’Fallon WM (1994a) Recurrent spontaneous cervical– artery dissection. N Engl J Med 330:393–397
Bassetti C, Carruzzo A, Sturzenegger M, Tuncdogan E (1996) Recurrence of cervical artery dissection. A prospective study of 81 patients. Stroke 27:1804–1807
Schievink WI, Mokri B, Piepgras DG (1994b) Spontaneous dissection of cervicocephalic arteries in childhood and adolescence. Neurology 44:1607–1612
Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344:898–906
Bogousslavsky J, Pierre P (1992) Ischemic stroke in patients under age 45. Neurol Clin 10:113–124
Bevan H, Sharma K, Bradley W (1990) Stroke in young adults. Stroke 21:382–386
Kasner SE, Hankins LL, Bratina P, Morgenstern LB (1997) Magnetic resonance angiography demonstrates vascular healing of carotid and vertebral artery dissections. Stroke 28:1993–1997
Djouhri H, Guillon B, Brunereau L, et al. (2000) MR angiography for the long–term follow–up of dissecting aneurysms of the extracranial internal carotid artery. AJR Am J Roentgenol 174:1137–1140
Kirsch E, Kaim A, Engelter S, et al. (1998) MR angiography in internal carotid artery dissection: improvement of diagnosis by selective demonstration of the intramural haematoma. Neuroradiology 40:704–709
Houser OW, Mokri B, Sundt TM, Baker HL, Reese DF (1983) Spontaneous cervical cephalic arterial dissection and its residuum: angiographic spectrum. AJNR Am J Neuroradiol 5:27–34
De Bray J–M, Lhoste P, Dubas F, Emile J, Saumet J–L (1994) Ultrasonic features of extracranial carotid dissections: 47 cases studied by angiography. J Ultrasound Med 13:659–664
Sturzenegger M, Mattle HP, Rivoir A, Baumgartner RW (1995a) Ultrasound findings in carotid artery dissection: analysis of 43 patients. Neurology 45:691–698
Srinivasan J, Newell DW, Sturzenegger M, Mayberg MR, Winn HR (1996) Transcranial Doppler in the evaluation of internal carotid artery dissection. Stroke 27:1226–1230
Steinke W, Rautenberg W, Schwartz A, Hennerici M (1994) Noninvasive monitoring of internal carotid artery dissection. Stroke 25:998–1005
Baumgartner RW, Arnold M, Baumgartner I, Mosso M, Gonner F, Studer A, Schroth G, Schuknecht B, Sturzenegger M (2001) Carotid dissection with and without ischemic events: local symptoms and cerebral artery findings. Neurology 11(57):827–832
Ozdoba C, Sturzenegger M, Schroth G (1996) Internal carotid artery dissection: MR imaging features and clinicalradiologic correlation. Radiology 199:191–198
Sturzenegger M (1995b) Spontaneous internal carotid artery dissection: early diagnosis and management in 44 patients. J Neurol 242:231–238
Sturzenegger M, Mattle HP, Rivoir A, Rihs F, Schmid C (1993) Ultrasound findings in spontaneous extracranial vertebral artery dissection. Stroke 24:1910–1921
Gelbert F, Assouline E, Hodes JE, Reizine D, Woimant F, George B, Hagueneau M, Merland JJ (1991) MRI in spontaneous dissection of vertebral and carotid arteries. 15 cases studied at 0. 5 tesla. Neuroradiology 33:111–113
Hosoya T, Adachi M, Yamaguchi K, Haku T, Kayama T, Kato T (1999) Clinical and neuroradiological features of intracranial vertebrobasilar artery dissection. Stroke 30:1083–1090
Zuber M, Meary E, Meder JF, Mas JL (1994) Magnetic resonance imaging and dynamic CT scan in cervical artery dissections. Stroke 25:576–581
Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, Kuhlenbaumer G, Stogbauer F, Ringelstein EB (2003) Cervical artery dissection – clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 250:1179–1184
Lisovoski F, Rousseaux P (1991) Cerebral infarction in young people. A study of 148 patients with early cerebral angiography. J Neurol Neurosurg Psychiatry 54:576–579
Provenzale JM, Morgenlander JC, Gress D (1996) Spontaneous vertebral dissection: clinical, conventional angiographic, CT, and MR findings. J Comput Assist Tomogr 20:185–193
Biousse V, D’Anglejan–Chatillon J, Touboul PJ, Amarenco P, Bousser MG (1995) Time course of symptoms in extracranial carotid artery dissections. A series of 80 patients. Stroke 26:235–239
Mokri B, Silbert PL, Schievink WI, Piepgras DG (1996) Cranial nerve palsy in spontaneous dissection of the extracranial internal carotid artery. Neurology 46:356–359
Silbert PL, Mokri B, Schievink WI (1995) Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology 45:1517–1522
Mas JL, Bousser MG, Hasboun D, Laplane D (1987) Extracranial vertebral artery dissections: a review of 13 cases. Stroke 18:1037–1047
Saeed AB, Shuaib A, Al–Sulaiti G, Emery D (2000) Vertebral artery dissection: warning symptoms, clinical features and prognosis in 26 patients. Can J Neurol Sci 27:292–296
Bogousslavsky J, Despland PA, Regli F (1987) Spontaneous carotid dissection with acute stroke. Arch Neurol 44:137–140
Treiman GS, Treiman RL, Foran RF, et al. (1996) Spontaneous dissection of the internal carotid artery: a nineteenyear clinical experience. J Vasc Surg 24:597–607
Logason K, Hardemark HG, Barlin T, Bergqvist D, Ahlstom H, Karacagil S (2002) Duplex scan findings in patients with spontaneous cervical artery dissections. Eur J Vasc Endovasc Surg 23:295–298
Early TF, Gregory RT, Wheeler JR, Snyder SO Jr, Gayle RG, Parent FN 3rd, Sorrell K (1991) Spontaneous carotid dissection: duplex scanning in diagnosis and management. J Vasc Surg 14:391–397
Mullges W, Ringelstein EB, Leibold M (1992) Non–invasive diagnosis of internal carotid artery dissections. J Neurol Neurosurg Psychiatry 55:98–104
Oelerich M, Stogbauer F, Kurlemann G, Schul C, Schuierer G (1999) Craniocervical artery dissection: MR imaging and MR angiographic findings. Eur Radiol 9:1385–1391
Leclerc X, Lucas C, Godefroy O, Tessa H, Martinat P, Leys D, Pruvo JP (1998) Helical CT for the follow–up of cervical internal carotid artery dissections. AJNR Am J Neuroradiol 19:831–837
Leclerc X, Godefroy O, Salhi A, Lucas C, Leys D, Pruvo JP (1996) Helical CT for the diagnosis of extracranial internal carotid artery dissection. Stroke 27:461–466
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Dittrich, R., Dziewas, R., Ritter, M.A. et al. Negative ultrasound findings in patients with cervical artery dissection. J Neurol 253, 424–433 (2006). https://doi.org/10.1007/s00415-005-0051-5
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DOI: https://doi.org/10.1007/s00415-005-0051-5