Vadim Beletsky, MD, PhD, Senior Stroke Fellow, Department of Clinical Neurological Sciences, London Health Sciences Centre, London, ON.
Clinical presentation of cervical arterial dissection is highly variable, but headache or neck pain is frequently observed. Both invasive and noninvasive imaging are used to confirm the diagnosis but noninvasive techniques overshadow traditional digital subtraction angiography (DSA), which should be reserved for cases where invasive procedures are planned. In spite of the accumulated clinical, diagnostic, and etiological data on cervical arterial dissections in recent years, there is no evidence to support the use of a particular class of antithrombotic agents in these patients. Different pathophysiology of brain ischemia in acute and chronic states of dissection may advocate different treatment strategies, including surgical. There are also no imaging follow-up guidelines, both in terms of frequency and modality, further affecting secondary stroke prevention uncertainties.
Key words: arterial dissection, cervical, stroke, carotid, vertebral.
