An Analysis of the Etiology of
Cervical Artery Dissections:
1994 to 2003

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   J Manipulative Physiol Ther 2005 (Oct); 28 (8): 617–622 ~ FULL TEXT

OPEN ACCESS

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Michael T. Haneline, DC, MPH, Gary N. Lewkovich, DC

Palmer College of Chiropractic West,
San Jose, CA 95134, USA.

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Objective:   To provide a literature review of the etiologic breakdown of cervical artery dissections.

Methods:   A literature search of the MEDLINE database was conducted for English-language articles published from 1994 to 2003 using the search terms cervical artery dissection (CAD), vertebral artery dissection, and internal carotid artery dissection. Articles were selected for inclusion only if they incorporated a minimum of 5 case reports of CAD and contained sufficient information to ascertain a plausible etiology.

Results:   One thousand fourteen citations were identified; 20 met the selection criteria. There were 606 CAD cases reported in these studies; 321 (54%) were internal carotid artery dissection and 253 (46%) were vertebral artery dissection, not including cases with both. Three hundred seventy-one (61%) were classified as spontaneous, 178 (30%) were associated with trauma/trivial trauma, and 53 (9%) were associated with cervical spinal manipulation. If one apparently biased study is dropped from the data pool, the percentage of CADs related to cervical spinal manipulation drops to approximately 6%.

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Conclusions:   The case series that were reviewed in this article indicated that most CADs reported in the previous decade were spontaneous but that some were associated with trauma/trivial trauma, and a minority with cervical spine manipulation. This etiologic breakdown of CAD does not differ significantly from what has been portrayed by most other authors.

Key Indexing Terms:   Cervical Artery Dissection, Trauma, Manipulation, Neck, Vertebral Artery

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References:

1. Hart RG Easton JD
   Dissections of cervical and cerebral arteries.
   Neurol Clin. 1983; 1: 155-182

2. Anson J Crowell RM
   Cervicocranial arterial dissection.
   Neurosurgery. 1991; 29: 89-96

3. Atkinson JL Piepgras DG Huston J Mokri B
   Cervical artery dissections: evidence for redissection
   in previously dissected arteries: report of three cases.
   Neurosurgery. 2002; 51: 797-801

4. Dziewas R Konrad C Drager B Evers S Besselmann M Ludemann P et al.
   Cervical artery dissection: clinical features, risk factors,
   therapy and outcome in 126 patients.
   J Neurol. 2003; 250: 1179-1184

5. Luscher TF Lie JT Stanson AW Houser OW Hollier LH Sheps SG
   Arterial fibromuscular dysplasia.
   Mayo Clin Proc. 1987; 62: 931-952

6. Brandt T Orberk E Weber R Werner I Busse O Muller BT et al.
   Pathogenesis of cervical artery dissections:
   association with connective tissue abnormalities.
   Neurology. 2001; 57: 24-30

7. Schievink WI Mokri B Piepgras DG
   Spontaneous dissections of cervicocephalic arteries
   in childhood and adolescence.
   Neurology. 1994; 44: 1607-1612

8. Ozdoba C Sturzenegger M Schroth G
   Internal carotid artery dissection: MR imaging features
   and clinical-radiologic correlation.
   Radiology. 1996; 199: 191-198

9. Blunt SB Galton C
   Cervical carotid or vertebral artery dissection.
   BMJ. 1997; 314: 243

10. Guillon B Berthet K Benslamia L Bertrand M Bousser MG Tzourio C
    Infection and the risk of spontaneous cervical
    artery dissection: a case-control study.
    Stroke. 2003; 34: e79-e81

11. Gallai V Caso V Paciaroni M Cardaioli G Arning E Bottiglieri T et al.
    Mild hyperhomocyst(e)inemia: a possible risk factor
    for cervical artery dissection.
    Stroke. 2001; 32: 714-718

12. Biousse V D'Anglejan-Chatillon J Touboul PJ Amarenco P Bousser MG
    Time course of symptoms in extracranial carotid artery dissections.
    A series of 80 patients.
    Stroke. 1995; 26: 235-239

13. Prabhakar S Bhatia R Khandelwal N Lal V Das CP
    Vertebral artery dissection due to indirect neck trauma:
    an underrecognised entity.
    Neurol India. 2001; 49: 384-390

14. Pezzini A Hausser I Brandt T Padovani A Grond-Ginsbach C
    Internal carotid artery dissection after French horn playing.
    Spontaneous or traumatic event?
    J Neurol. 2003; 250: 1004-1005

15. Schievink WI
    Spontaneous dissection of the carotid and vertebral arteries.
    N Engl J Med. 2001; 344: 898-906

16. Schievink WI Mokri B Whisnant JP
    Internal carotid artery dissection in a community.
    Rochester, Minnesota, 1987-1992.
    Stroke. 1993; 24: 1678-1680

17. Giroud M Fayolle H Andre N Dumas R Becker F Martin D et al.
    Incidence of internal carotid artery dissection
    in the community of Dijon.
    J Neurol Neurosurg Psychiatry. 1994; 57: 1443

18. Schievink WI Mokri B O'Fallon WM
    Recurrent spontaneous cervical-artery dissection.
    N Engl J Med. 1994; 330: 393-397

19. Silbert PL Mokri B Schievink WI
    Headache and neck pain in spontaneous internal carotid
    and vertebral artery dissections.
    Neurology. 1995; 45: 1517-1522

20. Haneline M Croft A Frishberg B
    Association of internal carotid artery dissection
    and chiropractic manipulation.
    Neurologist. 2003; 9: 35-44

21. Mas JL Bousser MG Hasboun D Laplane D
    Extracranial vertebral artery dissections:
    a review of 13 cases.
    Stroke. 1987; 18: 1037-1047

22. Mokri B
    Traumatic and spontaneous extracranial
    internal carotid artery dissections.
    J Neurol. 1990; 237: 356-361

23. Biller J Hingtgen WL Adams HP Smoker WR Godersky JC Toffol GJ
    Cervicocephalic arterial dissections.
    A ten-year experience.
    Arch Neurol. 1986; 43: 1234-1238

24. Desfontaines P Despland PA
    Dissection of the internal carotid artery: aetiology, symptomatology,
    clinical and neurosonological follow-up, and treatment in 60 consecutive cases.
    Acta Neurol Belg. 1995; 95: 226-234

25. Saeed AB Shuaib A Al-Sulaiti G Emery D
    Vertebral artery dissection: warning symptoms,
    clinical features and prognosis in 26 patients.
    Can J Neurol Sci. 2000; 27: 292-296

26. Frisoni G Anzola G
    Vertebrobasilar ischemia after neck motion.
    Stroke. 1991; 22: 1452-1460

27. Bassi P Lattuada P Gomitoni A
    Cervical cerebral artery dissection:
    a multicenter prospective study (preliminary report).
    Neurol Sci. 2003; 24: S4-S7

28. Chabrier S Lasjaunias P Husson B Landrieu P Tardieu M
    Ischaemic stroke from dissection of the craniocervical arteries
    in childhood: report of 12 patients.
    Eur J Paediatr Neurol. 2003; 7: 39-42

29. Gonzales-Portillo F Bruno A Biller J
    Outcome of extracranial cervicocephalic arterial dissections:
    a follow-up study.
    Neurol Res. 2002; 24: 395-398

30. Pezzini A, Del Zotto E, Archetti S, Negrini R, Bani P, Albertini A, et al.
    Plasma Homocysteine Concentration, C677T MTHFR Genotype, and
    844ins68bp Genotype in Young Adults With Spontaneous Cervical
    Artery Dissection and Atherothrombotic Stroke
    Stroke 2002 (Mar); 33 (3): 664-669

31. Camacho A Villarejo A de Aragon AM Simon R Mateos F
    Spontaneous carotid and vertebral artery dissection in children.
    Pediatr Neurol. 2001; 25: 250-253

32. Norris JW, Beletsky V, Nadareishvili ZG.
    Sudden Neck Movement and Cervical Artery Dissection
    CMAJ. 2000 (Jul 11); 163 (1): 38–40

33. Shin JH Suh DC Choi CG Leei HK
    Vertebral artery dissection: spectrum of imaging findings with
    emphasis on angiography and correlation with clinical presentation.
    Radiographics. 2000; 20: 1687-1696

34. Ahmad HA Gerraty RP Davis SM Cameron PA
    Cervicocerebral artery dissections.
    J Accid Emerg Med. 1999; 16: 422-424

35. Auer A Felber S Schmidauer C Waldenberger P Aichner F
    Magnetic resonance angiographic and clinical features
    of extracranial vertebral artery dissection.
    J Neurol Neurosurg Psychiatry. 1998; 64: 474-481

36. Brandt T Hausser I Orberk E Grau A Hartschuh W Anton-Lamprecht I et al.
    Ultrastructural connective tissue abnormalities in patients
    with spontaneous cervicocerebral artery dissections.
    Ann Neurol. 1998; 44: 281-285

37. de Bray JM Penisson-Besnier I Dubas F Emile J
    Extracranial and intracranial vertebrobasilar dissections:
    diagnosis and prognosis.
    J Neurol Neurosurg Psychiatry. 1997; 63: 46-51

38. Mascalchi M Bianchi MC Mangiafico S Ferrito G Puglioli M Marin E et al.
    MRI and MR angiography of vertebral artery dissection.
    Neuroradiology. 1997; 39: 329-340

39. Sidhu PS Jonker ND Khaw KT Patel N Blomley MJ Chaudhuri KR et al.
    Spontaneous dissections of the internal carotid artery:
    appearances on colour Doppler ultrasound.
    Br J Radiol. 1997; 70: 50-57

40. Bakke SJ Smith HJ Kerty E Dahl A Cervicocranial artery dissection.
    Detection by Doppler ultrasound and MR angiography.
    Acta Radiol. 1996; 37: 529-534

41. Sturzenegger M
    Headache and neck pain:
    the warning symptoms of vertebral artery dissection.
    Headache. 1994; 34: 187-193

42. Tzourio C Benslamia L Guillon B Aidi S Bertrand M Berthet K et al.
    Migraine and the risk of cervical artery dissection:
    a case-control study.
    Neurology. 2002; 59: 435-437

43. Grau AJ Brandt T Buggle F Orberk E Mytilineos J Werle E et al.
    Association of cervical artery dissection with recent infection.
    Arch Neurol. 1999; 56: 851-856

44. Sturzenegger M
    Spontaneous internal carotid artery dissection:
    early diagnosis and management in 44 patients.
    J Neurol. 1995; 242: 231-238

45. Steinke W Rautenberg W Schwartz A Hennerici M
    Noninvasive monitoring of internal carotid artery dissection.
    Stroke. 1994; 25: 998-1005

46. Smith WS Johnston SC Skalabrin EJ Weaver M Azari P Albers GW et al.
    Spinal manipulative therapy is an independent risk factor
    for vertebral artery dissection.
    Neurology. 2003; 60: 1424-1428

47. Rothwell DM, Bondy SJ, Williams JI.
    Chiropractic Manipulation and Stroke:
    A Population-based Case-control Study
    Stroke 2001 (May); 32 (5): 1054-1060

48. Bartels E Flugel KA
    Evaluation of extracranial vertebral artery dissection
    with duplex color-flow imaging.
    Stroke. 1996; 27: 290-295

49. Brandt T Grond-Ginsbach C
    Spontaneous cervical artery dissection:
    from risk factors toward pathogenesis.
    Stroke. 2002; 33: 657-658

50. Muller BT Luther B Hort W Neumann-Haefelin T Aulich A Sandmann W
    Surgical treatment of 50 carotid dissections:
    indications and results.
    J Vasc Surg. 2000; 31: 980-988

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