Vertebral artery dissection – aetiology, clinical features and treatment
1 Katedra i Klinika Neurologii Uniwersytetu Medycznego we Wrocławiu, Uniwersytecki Szpital Kliniczny we Wrocławiu
2 Zakład Radiologii Ogólnej, Zabiegowej i Neuroradiologii Katedry Radiologii Uniwersytetu Medycznego we Wrocławiu, Uniwersytecki Szpital Kliniczny we Wrocławiu
Adres do korespondencji: Katedra i Klinika Neurologii, Uniwersytecki Szpital Kliniczny we Wrocławiu, ul. Borowska 213, 50-556 Wrocław, tel.: +48 71 734 31 00, e-mail: justyna.chojdak@wp.pl
Aktualn Neurol 2014, 14 (4), p. 250–256
DOI: 10.15557/AN.2014.0029
ABSTRACT

Dissection of the extracranial carotid and vertebral arteries is responsible for 2–3% of all strokes and for 20% of ischaemic events in the population of young people under the age of 45. Vertebral artery dissection is a very rare yet serious condition. The annual overall incidence of vertebral artery dissection is estimated at 1 to 1.5 per 100 000 persons. Its clinical manifestation is very nonspecific and diverse. The most typical clinical sign is sudden unilateral headache accompanied by neck pain. Other symptoms include systemic and non-systemic headaches as well as infarction or transient ischaemic attack in posterior circulation territorial area inn case where the intracranial vertebral artery dissection is associated with subarachnoid haemorrhage. The aetiology of dissection remains unclear and connected with multiple risk factors. Vertebral artery dissection can be caused by blunt force trauma of the head or neck or it can be spontaneous. The aetiology of spontaneous vertebral artery dissection includes vascular and genetic factors as well as structural defects of the arterial wall associated with connective tissue disorders. The diagnosis of vertebral artery dissection has to be established based on anamnesis, clinical features and imaging examination. Catheter cerebral angiography is the gold standard of diagnosis of arterial dissection, but also computed tomography angiography has been proven to have a very high sensitivity and specificity. In most cases extracranial vertebral artery dissection carries a good prognosis. The treatment of vertebral artery dissection is conservative and includes the use of anticoagulation and antiplatelet drugs. Surgical or endovascular treatment can be applied only for selected and small group of patients. Authors emphasize that clinical features can be very unspecific and vertebral dissection may be misdiagnosed especially in the first hours following the manifestation of symptoms. Vertebral artery dissection should be taken into consideration in the diagnosis of stroke in young persons despite unspecified symptoms and without traumatic history.

Keywords: vertebral artery dissection, ischaemic stroke, neck trauma, headache, computed tomography angiography