scholarly journals Diagnosis and outcome of cervical artery dissection

2011 ◽  
Vol 64 (7-8) ◽  
pp. 392-396 ◽  
Author(s):  
Ivana Divjak ◽  
Petar Slankamenac ◽  
Mirjana Jovicevic ◽  
Tamara Rabi-Zikic ◽  
Aleksandar Jesic
Keyword(s):  
Young Adults ◽  
Magnetic Resonance ◽  
Functional Outcome ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Long Term Outcome ◽  
Stroke In Young Adults ◽  
Malignant Infarction ◽  
Cervical Artery ◽  
Stroke In Young

Introduction. Spontaneous dissection of the cervical artery is a rare non-atherosclerotic vascular disease of unknown aetiology and unclear pathogenesis that may be a cause of ischemic stroke in young adults. Diagnosis. Precise diagnosis of dissection of the cervical artery - carotid or vertebral - is possible with cervical axial magnetic resonance imaging and magnetic resonance angiography. Treatment. The recommended treatment in the acute phase of cervical artery dissection is anticoagulant or antithrombotic therapy, aimed at preventing a primary or recurrent ischemic event. There have been as yet no results of randomized controlled studies comparing efficacy of both treatments. An ongoing randomized multicentre study is expected to provide answers about the effects of these treatments in cervical artery dissection. Outcome. Complete resolution of arterial abnormalities is achieved in around 46% of stenoses, 33% of occlusions, and 12% of dissecting aneurysms. Recurrent events. Recurrence of cerebral ischemia and cervical artery dissection seems to be rare, although some data suggest that early ischemic and late cervical artery dissection recurrences could be underestimated. Mortality and functional outcome. In comparison with other causes of stroke in young adults, the functional outcome of cervical artery dissection is good in contrast to its socio-professional effects, which may be unsatisfactory. The mortality rate of cervical artery dissection is low, although it may be underestimated since some patients with malignant infarction die before the diagnosis is established. Conclusion. Further research is warranted to improve our understanding of the underlying pathophysiology, to assess the long-term outcome, and ultimately to provide treatment and prevention strategies.

Migraine improvement after spontaneous cervical artery dissection the Italian Project on Stroke in Young Adults (IPSYS)

2018 ◽  
Vol 40 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Valeria De Giuli ◽  
◽  
Francesca Graziano ◽  
Andrea Zini ◽  
Marialuisa Zedde ◽  
...  
Keyword(s):  
Young Adults ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke In Young Adults ◽  
Cervical Artery ◽  
Stroke In Young

Ischemic Stroke in Young Adults Caused by Cervical Artery Dissection—A Retrospective Study

2021 ◽  
Author(s):  
Lucija Jazbec ◽  
Marija Menih ◽  
Rok Arh
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Retrospective Study ◽  
Arterial Hypertension ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke In Young Adults ◽  
Cervical Artery ◽  
Stroke In Young

Abstract Background Ischemic stroke is one of the most common causes of death and disability. The most common independent cause is cervical artery dissection, which represents around 20% of all cases of ischemic stroke in young adults. Risk factors for dissection include male gender, migraine (particularly with aura), hyperhomocysteinemia, recent infection, recent history of minor cervical trauma, young age, current smoking status, increased leucocyte count, and shortened activated partial thromboplastin time, whereas hypercholesterolemia and being overweight appear protective. Patients and Methods This retrospective study was based on data of all patients aged 18 to 49 who were hospitalized in the University Medical Centre Maribor for ischemic stroke between 2010 and 2019 inclusive. The results of the research were analyzed by IBM SPSS Statistics 28 software. For statistical significance, a cut-off value of p < 0.05 was used. Results The study includes 196 patients with 198 events of ischemic stroke. Dissection of cervical arteries was presented in 16 (8.2%) cases. The presence of arterial hypertension proved to have a relation with the presence of a dissection; patients with dissection are less likely to suffer from arterial hypertension. Duration of hospitalization in the group with dissection lasted significantly longer than in the group without dissection. Conclusions Dissection of cervical or intracranial artery is an important cause of ischemic stroke, especially in young adults. Therefore, it should be considered in young adults with presentation of stroke who lack traditional and modifiable risk factors.

scholarly journals Association of Vascular Risk Factors With Cervical Artery Dissection and Ischemic Stroke in Young Adults

Circulation ◽  
2011 ◽  
Vol 123 (14) ◽  
pp. 1537-1544 ◽  
Author(s):  
Stéphanie Debette ◽  
Tiina Metso ◽  
Alessandro Pezzini ◽  
Shérine Abboud ◽  
Antti Metso ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Vascular Risk Factors ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Vascular Risk ◽  
Stroke In Young Adults ◽  
Cervical Artery ◽  
Stroke In Young

scholarly journals Stroke in young adults

2018 ◽  
Vol 8 (6) ◽  
pp. 501-506 ◽  
Author(s):  
Nirav Bhatt ◽  
Amer M. Malik ◽  
Seemant Chaturvedi
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Management Strategies ◽  
Cryptogenic Stroke ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Stroke In Young Adults ◽  
New Information ◽  
Traditional Risk Factors ◽  
Stroke In Young

Purpose of reviewThe incidence of stroke in young adults is increasing, mainly driven by an increasing incidence of ischemic stroke in this population. We provide new information that has been recently presented regarding the risk factor prevalence, some specific etiologic causes, and management strategies in ischemic stroke in this population.Recent findingsRecent studies indicate a rapid increase in traditional risk factors in young adults. New information regarding the management of patent foramen ovale in cryptogenic stroke and cervical artery dissection is available.SummaryStroke in young adults is a rapidly growing problem with deep public health implications. There are many areas in this field, which require further research.

scholarly journals Combined Anticoagulation and Antiaggregation in Acute Cervical Artery Dissection

2021 ◽  
Vol 10 (19) ◽  
pp. 4580
Author(s):  
Philipp von von Gottberg ◽  
Victoria Hellstern ◽  
Christina Wendl ◽  
Marc E. Wolf ◽  
Ludwig Niehaus ◽  
...  
Keyword(s):  
Adverse Events ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Residual Stenosis ◽  
Stroke In Young Adults ◽  
Cervical Artery ◽  
Insignificant Difference ◽  
Major Adverse Events ◽  
Stroke In Young

Cervical artery dissection (CAD) is a frequent cause of stroke in young adults. Previous studies investigating the efficiency of anticoagulation (AC) versus antiplatelet therapy (AT) found an insignificant difference. We therefore retrospectively evaluated a combination of AC plus AT in patients with acute CAD regarding safety and efficacy. Twenty-eight patients with CAD and minor neurological symptoms/no major infarction received either single (n = 14) or dual AT (n = 14) combined with AC. Angiographic follow-up during hospitalization, 4-8 weeks and 3–6 months after CAD focused on occlusion, residual stenosis, and functional recanalization. Possible adverse events were surveyed. We compared the AC plus AT group to 22 patients with acute CAD treated with AC or AT. Compared to preceding AC-/AT-only studies, AC plus single or dual AT resulted in more frequent, faster recanalization. Frequency and severity of adverse events was comparable. No major adverse events or death occurred. Preceding works on conservative treatment of CAD are discussed and compared to this study. Considerations are given to pathophysiology and the dynamic of CAD. Combining AC plus AT in CAD may result in more reliable recanalization in a shorter time. The risk for adverse events appears similar to treatment with only AC or AT.

Post-stroke fatigue and its association with poor functional outcome after stroke in young adults

2014 ◽  
Vol 86 (10) ◽  
pp. 1120-1126 ◽  
Author(s):  
Noortje A M M Maaijwee ◽  
Renate M Arntz ◽  
Loes C A Rutten-Jacobs ◽  
Pauline Schaapsmeerders ◽  
Henny C Schoonderwaldt ◽  
...  
Keyword(s):  
Young Adults ◽  
Functional Outcome ◽  
Poor Functional Outcome ◽  
Post Stroke ◽  
Stroke In Young Adults ◽  
Stroke In Young

scholarly journals Magnetic Resonance Imaging and Clinical Factors Associated With Ischemic Stroke in Patients Suspected of Cervical Artery Dissection

Stroke ◽  
2018 ◽  
Vol 49 (10) ◽  
pp. 2337-2344 ◽  
Author(s):  
J. Scott McNally ◽  
Peter J. Hinckley ◽  
Akihiko Sakata ◽  
Laura B. Eisenmenger ◽  
Seong-Eun Kim ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Resonance Imaging ◽  
Clinical Factors ◽  
Factors Associated ◽  
Cervical Artery

scholarly journals Biomarkers and antithrombotic treatment in cervical artery dissection – Design of the TREAT-CAD randomised trial

2020 ◽  
Vol 5 (3) ◽  
pp. 309-319
Author(s):  
Christopher Traenka ◽  
Henrik Gensicke ◽  
Sabine Schaedelin ◽  
Andreas Luft ◽  
Marcel Arnold ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Resonance Imaging ◽  
Antithrombotic Treatment ◽  
Data Set ◽  
Cervical Artery

Introduction The type of antithrombotic treatment in cervical artery dissection patients is still a matter of debate. Most physicians prefer anticoagulants over antiplatelet agents for stroke prevention. However, this approach is not evidence-based and antiplatelets might be as safe and as effective. The ‘Biomarkers and Antithrombotic Treatment in Cervical Artery Dissection’ (‘TREAT-CAD’) trial (clinicaltrials.gov: NCT02046460) compares Aspirin to oral anticoagulants (vitamin K antagonists) with regard to efficacy and safety by using both clinical and imaging surrogate outcome measures. TREAT-CAD tests the hypothesis, that aspirin is as safe and effective as vitamin K antagonists. Patients and methods TREAD-CAD is a Prospective, Randomised controlled, Open-labelled, multicentre, non-inferiority trial with Blinded assessment of outcome Events (PROBE-design). Key eligibility criteria are (i) clinical symptoms attributable to cervical artery dissection and (ii) verification of the cervical artery dissection diagnosis by established magnetic resonance imaging criteria. Patients are randomised to receive either Aspirin 300 mg daily or vitamin K antagonists for 90 days. Results Primary outcomes are assessed at 14 ± 10 days (magnetic resonance imaging and clinical examination) and at 90 ± 30 days (clinical examinations). The primary endpoint is a composite outcome measure – labelled Cerebrovascular Ischemia, major Hemorrhagic events or Death (CIHD) – and includes (i) occurrence of any stroke (including retinal infarction), (ii) new ischaemic lesions on diffusion-weighted magnetic resonance imaging, (iii) any major extracranial haemorrhage, (iv) any symptomatic intracranial haemorrhage, (v) any new haemorrhagic lesion visible on paramagnetic-susceptible sequences and (vi) death. Discussion After database closure, (i) central verification of cervical artery dissection diagnosis will be done by two experienced raters, (ii) adjudication of outcome events will be performed by independent adjudication committees, separately for clinical and imaging outcomes. The primary analysis will be done on the per protocol data set. The targeted sample size consists of 169 evaluable patients in the per protocol data set. Conclusion TREAT-CAD is testing the non-inferiority of Aspirin versus vitamin K antagonists treatment in patients with symptomatic cervical artery dissection by combined clinical and magnetic resonance imaging outcomes.

scholarly journals Smoking Status and Functional Outcomes in Young Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Cheng-Loong Liang ◽  
Han-Jung Chen ◽  
Yi-Che Lee ◽  
Cheng-Chun Wu ◽  
Chon-Haw Tsai ◽  
...  
Keyword(s):  
Young Adults ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Cox Model ◽  
Smoking Status ◽  
Age Difference ◽  
Higher Alcohol ◽  
Young Stroke ◽  
Stroke In Young Adults ◽  
Stroke In Young

Objective: Stroke in young adults is uncommon, and the etiologies and risk factors of stroke in young adults differ from those in older populations. Smoker's paradox is an unexpected favorable outcome, and age difference is used to explain the association between smoking and the favorable functional outcome. This study aimed to investigate the existence of this phenomenon in young stroke patients.Methods: We analyzed a total of 9,087 young stroke cases registered in the nationwide stroke registry system of Taiwan between 2006 and 2016. Smoking criteria included having a current history of smoking more than one cigarette per day for more than 6 months. After matching for sex and age, a Cox model was used to compare mortality and function outcomes between smokers and non-smokers.Results: Compared with the non-smoker group, smoking was associated with older age, higher comorbidities, and higher alcohol consumption. Patients who report smoking with National Institutes of Health Stroke Scale scores of 11–15 had a worse functional outcome (adjusted odds ratio, 0.81; 95% confidence interval, 0.76 – 0.87).Conclusion: Smokers had a higher risk of unfavorable functional outcomes at 3 months after stroke, and therefore, we continue to strongly advocate the importance of smoking cessation.

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