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Wood EC, Marcet PA, Fargen KM, Velazquez-Ramirez G. Contemporary Management and Outcomes of Carotid Artery Dissection. Ann Vasc Surg 2025; 113:406-414. [PMID: 39343363 DOI: 10.1016/j.avsg.2024.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 10/01/2024]
Abstract
Carotid artery dissection is a significant cause of stroke and the leading etiology of ischemic stroke in young and middle-aged individuals. The management of carotid artery dissection is continually evolving and varies based on the patient's clinical presentation. While carotid dissection is typically managed medically, endovascular intervention may be warranted in certain cases, and open surgical intervention is rarely employed. This qualitative review examines contemporary management strategies for cervical carotid artery dissection, highlighting 3 illustrative cases where endovascular intervention was utilized. We present one case of traumatic etiology with acute stroke symptoms, another traumatic case with progressing dissection and pseudoaneurysm evident on imaging, and a case of iatrogenic carotid dissection. Through these cases, we aim to elucidate the decision-making process and outcomes associated with endovascular treatment in the context of carotid artery dissection.
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Affiliation(s)
- Elizabeth C Wood
- Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Paul A Marcet
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Gabriela Velazquez-Ramirez
- Department of Vascular and Endovascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.
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Trager RJ, Haering CP, Baumann AN, Wright DS. Association between combined oral contraceptive prescription and cervical artery dissection: A retrospective cohort study. Thromb Res 2025; 247:109279. [PMID: 39923282 DOI: 10.1016/j.thromres.2025.109279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 01/01/2025] [Accepted: 02/01/2025] [Indexed: 02/11/2025]
Abstract
BACKGROUND To date, research has identified positive associations between combined oral contraceptives (COCs) and adverse vascular events, however, evidence regarding the possible association with cervical artery dissection (CeAD) remains limited. We tested the hypothesis of a positive association between COCs and CeAD within one year following COC initiation compared to matched controls initiating intrauterine devices (IUDs), as measured by risk ratio (RR). METHODS We queried de-identified United States health records data (TriNetX, Inc.) from 2014 to 2024 for females aged 15-50 years without previous cerebrovascular disease or CeAD, creating mutually exclusive cohorts initiating either COCs or IUDs. We used propensity matching to control for variables associated with CeAD. Our primary outcome included the RR for CeAD within one year follow-up. We secondarily explored cumulative CeAD incidence and RR of stroke, also examining outcomes for females with ≥2 COC prescriptions (COC2). RESULTS After matching there were 214,020 patients per cohort (mean age 31 years). The incidence and risk of CeAD was greater among those prescribed COCs compared to matched controls with IUDs [95 % CI] (COCs: 0.016 %, IUDs: 0.008 %; RR 1.94 [1.10,3.43]; P = 0.0195). A similar association was observed for stroke (COCs: 0.106 %, IUDs: 0.057 %; RR = 1.86 [1.49,2.32]; P < 0.0001). The secondary COC2 analysis revealed similar findings. CONCLUSIONS The present findings suggest that females prescribed COCs have an increased risk of CeAD and stroke compared to matched controls using IUDs. These observations should be viewed as preliminary, require corroboration by other studies, and in isolation do not replace the broader clinical and shared decision-making regarding contraceptive use.
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Affiliation(s)
- Robert J Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, NC, USA.
| | - Catherine P Haering
- Department of Reproductive Endocrinology and Infertility, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA; Department of Rehabilitation Services, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Debbie S Wright
- MSCR Student, Parker University, Dallas, TX, USA; Private practice, The Grove Health and Wellness, Courtenay, BC, Canada
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Zedde M, Quatrale R, Andreone V, Pezzella FR, Micieli G, Cortelli P, Sette MD, Pascarella R. Post-infectious central nervous system vasculitides in adults: an underdiagnosed and treatable disease part II. Neuroimaging of selected etiologies : Part II. Neuroimaging of selected etiologies. Neurol Sci 2025; 46:1073-1086. [PMID: 39663274 DOI: 10.1007/s10072-024-07938-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 12/07/2024] [Indexed: 12/13/2024]
Abstract
INTRODUCTION As detailed in the first part of this review, post-infectious vasculitides are a wide and complex category, including several clinical, microbiological and neuroradiological patterns. In order to raise the suspicion for diagnosis, the knowledge of two different neuroradiological issues is needed, i.e. the knowledge of neuroimaging pattern of infections and the one of neuroimaging pattern of vasculitis. AIMS The main aim of this second part is to summarize the neuroradiological features of post-infectious vasculitides focusing on imaging of vessels and consequences of vessel involvement, continuing the discussion proposed in the first part about neuroimaging of infections. In some cases, the two neuroradiological issues are both simultaneously present in the same patient, but in other cases only the second one can be depicted due to the latency between infection and vasculitis. FINDINGS Beyond general features of cerebral vascular involvement in post-infectious vasculitides, some well-studied and homogenous diseases, as treponemal vasculitis, Varicella Zoster Virus (VZV) arteriopathy, neuroborreliosis, SARS-CoV2-related endotheliopathy are described in detail, being not rare and sometimes underdiagnosed. The main clinical and neuroradiological features of these conditions are deeply addressed, providing diagnostic clues and pictorial examples. CONCLUSIONS Although some general features are common in clinical presentation and neuroimaging of post-infectious vasculitides, there are few neuroimaging clues pointing out a specific microbial agent as causative. The main step is to raise the diagnostic suspicion in order to start the dedicated investigation pathway and treatment.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia, 42122, Italy.
| | - Rocco Quatrale
- Dipartimento Di Scienze Neurologiche, UOC Di Neurologia, Ospedale Dell'Angelo AULSS 3 Serenissima, Venice Mestre, Italy
| | - Vincenzo Andreone
- Neurology and Stroke Unit, A.O.R.N. Antonio Cardarelli, Napoli, Italy
| | | | - Giuseppe Micieli
- Former Department of Emergency Neurology, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Pietro Cortelli
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
- DIBINEM, University of Bologna, Bologna, Italy
| | | | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, Reggio Emilia, 42122, Italy
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Xiao S, Zhang J, Wang L, Zhang H. Analysis of a delayed diagnosis of carotid artery aneurysm presenting as a parapharyngeal space infection. EAR, NOSE & THROAT JOURNAL 2025; 104:198S-201S. [PMID: 36189632 DOI: 10.1177/01455613221113811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is very rare for extracranial carotid artery dissection to present as a carotid pseudoaneurysm. A delayed diagnosis and delayed treatment will lead to rupture of carotid pseudoaneurysm and massive hemorrhage and death. In this paper, we reviewed the progress of the disease in one patient and reviewed the relevant literature reports to understand the characteristics of the disease. The patient had two consultations within the otolaryngology department. The patient later showed signs of infection in the parapharyngeal space and then died of an aneurysmal rupture and massive hemorrhage.
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Affiliation(s)
- Shufen Xiao
- Departments of Otorhinolaryngology-Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang, China
| | - Juan Zhang
- Department of Pharmacy, The Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
| | - Ling Wang
- Departments of Otorhinolaryngology-Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang, China
| | - Hong Zhang
- Departments of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Hospital of Hebei University of Engineering, Handan, China
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Alalfi MO, Cau R, Argiolas GM, Scicolone R, Mantini C, Nardi V, Benson JC, Suri JS, Keser Z, Lerman A, Lanzino G, Siotto P, Saba L. Assessment of Attenuation in Pericarotid Fat among Patients with Carotid Plaque and Spontaneous Carotid Dissection. AJNR Am J Neuroradiol 2025; 46:259-264. [PMID: 39848778 PMCID: PMC11878953 DOI: 10.3174/ajnr.a8546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 08/19/2024] [Indexed: 01/25/2025]
Abstract
BACKGROUND AND PURPOSE Changes in perivascular fat density (PFD) and its association with inflammation have been topics of interest in both atherosclerotic and nonatherosclerotic vasculopathies. The objective of this study was to assess the PFD in patients with spontaneous internal carotid artery dissection (SICAD) or carotid atherosclerotic plaque, with and without intraplaque hemorrhage (IPH). MATERIALS AND METHODS A cross-sectional retrospective bicentric analysis of 130 patients (30 with SICAD and 100 with carotid atherosclerotic plaque) who underwent CT angiography was performed. Among the subjects with atherosclerotic plaque, 36 showed the presence of IPH. PFD analysis was performed by 2 radiologists who placed 2 ROIs to identify the perivascular fat tissue attenuation. The Mann-Whitney U test was conducted to evaluate the difference between patient cohorts. RESULTS Carotid arteries with SICAD and IPH demonstrated an average PFD of -68.97 HU (95% CI, -72.11 to -65.82 HU) and -69.97 HU (95% CI, -73.00 to -66.95 HU), respectively, in comparison with patients without IPH, who showed an average PFD -77.11 HU (95% CI,-78.78 to -75.44 HU) (P < .001 for both). Conversely, no significant differences were found between patients with SICAD and those with carotid plaque with IPH (P = .324). CONCLUSIONS The average PFDs in patients with SICAD and carotid atherosclerosis plaque with IPH were similar and higher than those in patients with carotid plaque without IPH. This finding suggests a shared pathologic inflammatory mechanism in these 2 conditions. Studies comparing pathologic specimens directly with radiologic images may be needed to confirm this indirect hypothesis.
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Affiliation(s)
- Mohammed O Alalfi
- From the School of Medicine and Surger (M.O.A.), University of Bologna, Bologna, Italy
| | - Riccardo Cau
- Department of Radiology (R.C., R.S., L.S.), University of Cagliari, Cagliari, Italy
| | | | - Roberta Scicolone
- Department of Radiology (R.C., R.S., L.S.), University of Cagliari, Cagliari, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences (C.M.), 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Valentina Nardi
- Department of Cardiovascular Medicine (V.N., A.L.), Mayo Clinic, Rochester, Minnesota
| | - John C Benson
- Department of Radiology (J.C.B.), Mayo Clinic, Rochester, Minnesota
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division (J.S.S.), AtheroPoint LLC, Roseville, California
- Department of ECE (J.S.S.), Idaho State University, Pocatello, Idaho
- Graphics Era University (J.S.S.), Dehradun, India
- University Center for Research and Development (J.S.S.), Chandigarh University, Mohali, India
- Symbiosis Institute of Technology (J.S.S.), Nagpur Campus, Symbiosis International, Pune, India
| | - Zafer Keser
- Department of Neurology (Z.K.), Mayo Clinic, Rochester, Minnesota
| | - Amir Lerman
- Department of Cardiovascular Medicine (V.N., A.L.), Mayo Clinic, Rochester, Minnesota
| | - Giuseppe Lanzino
- Department of Neurologic Surgery (G.L.), Mayo Clinic, Rochester, Minnesota
| | - Paolo Siotto
- Department of Radiology (G.M.A., P.S.), Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Luca Saba
- Department of Radiology (R.C., R.S., L.S.), University of Cagliari, Cagliari, Italy
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Lee E, Shu L, Salehi Omran S, Goldstein ED, Henninger N, Nguyen TN, Siegler JE, Strelecky L, Khan F, Stretz C, Furie KL, Yaghi S. Differential outcomes and treatment in non-traumatic carotid versus vertebral cervical artery dissection: A national inpatient sample study. J Stroke Cerebrovasc Dis 2025; 34:108170. [PMID: 39647554 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 11/27/2024] [Accepted: 11/30/2024] [Indexed: 12/10/2024] Open
Abstract
INTRODUCTION Cervical artery dissection (CAD) involves the carotid or vertebral artery. However, limited studies have compared their clinical features and outcomes. METHODS We examined non-traumatic CAD patients from the National Inpatient Sample (2005-2019). Those diagnosed with both carotid and vertebral artery dissections were excluded. The evaluation included patient demographics, comorbidities, and treatment. Differences between carotid and vertebral dissections were assessed using survey-weighted stepwise backward logistic regression, followed by adjusted multivariable regressions for the primary outcomes of in-hospital mortality and routine discharge (to home or self-care). RESULTS From 2005 to 2019, we included 123,224 non-traumatic CAD admissions without concurrent vertebral and carotid dissections. There were more carotid dissections than vertebral dissections (67,533 vs. 55,691). Compared to vertebral dissection, carotid dissection was associated with older age (54 [44-66] years vs. 49 [37-62] years, P<0.001), Black race (12.6% vs. 8.8%, P<0.001), White race (73.5% vs. 72.0%, P = 0.024), atrial fibrillation (10.8% vs. 6.3%, P<0.001), aortic dissection (7.7% vs. 0.3%, P<0.001), and fewer concurrent acute ischemic strokes (AIS) (47.8% vs. 56.7%, P<0.001).Within the concurrent AIS group, carotid CAD patients exhibited higher NIHSS (8 [2-17] vs. 2 [0-5], P<0.001), an increased utilization of intravenous thrombolysis (6.7% vs. 2.7% P<0.001), endovascular therapy (13.3% vs. 3.3%, P<0.001), and angioplasties (9.8% vs. 0.3%, P<0.001). Overall, carotid CAD was associated with more inpatient deaths (aOR 1.30, 95% CI 1.04-1.62, P=0.023) and less routine discharges (aOR 0.88, 95% CI 0.79-0.97, P=0.014) than vertebral CAD. CONCLUSION Our study underscores distinct comorbidity profiles and treatment patterns between non-traumatic carotid dissection and vertebral dissection groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.
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Affiliation(s)
- Elizabeth Lee
- Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States.
| | - Liqi Shu
- Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States.
| | | | - Eric D Goldstein
- Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States.
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, United States; Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States.
| | - Thanh N Nguyen
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States.
| | - James E Siegler
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Lukas Strelecky
- Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States.
| | - Farhan Khan
- Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States.
| | - Christoph Stretz
- Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States.
| | - Karen L Furie
- Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States.
| | - Shadi Yaghi
- Department of Neurology, The Alpert Medical School of Brown University, 593 Eddy Street APC 5, Providence, RI 02903, United States
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Trager RJ, Lynn BP, Baumann AN, Chu ECP. Systemic lupus erythematosus is associated with an increased risk of cervical artery dissection. Sci Rep 2025; 15:1194. [PMID: 39775176 PMCID: PMC11707269 DOI: 10.1038/s41598-025-85655-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 01/06/2025] [Indexed: 01/11/2025] Open
Abstract
Limited evidence suggests that autoimmune diseases are associated with an increased risk of cervical artery dissection (CeAD). We hypothesized individuals with systemic lupus erythematosus (SLE) would have an increased risk of CeAD following SLE diagnosis compared to matched non-lupus controls. We queried a de-identified United States electronic medical records network (TriNetX, Inc.) for individuals aged 10 and older from 2012 to 2020, for two cohorts: (1) SLE and (2) non-lupus controls, excluding those with prior CeAD. We used propensity matching to control for confounding variables and calculated the risk ratio (RR) for CeAD occurring over four years' follow-up, secondarily exploring cumulative incidence. After matching, both cohorts contained 77,008 patients, who were mostly female (89%). The incidence and risk of CeAD was significantly greater among those with SLE compared to matched non-lupus controls [95% CI] (0.08% vs. 0.04%; RR = 2.33 [1.49;3.66]; P < 0.0001). These findings support the hypothesis that SLE is a risk factor for CeAD. Additional research is needed to identify the mechanisms that may underly the SLE-CeAD association and examine the potential association between other autoimmune diseases and CeAD.
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Affiliation(s)
- Robert J Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, 44106, OH, USA.
- Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, NC, USA.
| | | | - Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Department of Rehabilitation Services, University Hospitals, Cleveland, OH, USA
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Khalid A, Summerbell A, Jha P, Abdelhafiz AH. Cough-induced vertebral artery dissection: A case report and literature review. J R Coll Physicians Edinb 2024; 54:298-303. [PMID: 39390814 DOI: 10.1177/14782715241290309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2024] Open
Abstract
Spontaneous vertebral artery dissection (VAD) is common after minor neck trauma or abrupt neck manipulation, which may result in stroke. However, violent cough is a less recognised cause of VAD. Only a few cases are reported in the literature. We review the literature and report a case of a 62-year-old man who presented with a headache and neck pain following a period of intermittent coughing, which led to VAD and a cerebellar ischaemic stroke. He responded well to medical treatment and made a full recovery. Therefore, VAD should be considered in the differential diagnosis for patients presenting with neck pain and headache after episodes of violent coughing.
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Affiliation(s)
- A Khalid
- Stroke, Rotherham General Hospital, Rotherham, UK
| | - A Summerbell
- Geriatric Medicine Department, Rotherham General Hospital, Rotherham, UK
| | - P Jha
- Stroke, Rotherham General Hospital, Rotherham, UK
| | - A H Abdelhafiz
- Geriatric Medicine Department, Rotherham General Hospital, Rotherham, UK
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Kahan J, Zhang C, Liberman AL, Segal AZ, Murthy SB, Kim J, Kamel H, Merkler AE. Association between atherosclerotic disease and cervical artery dissection in a population-based cohort of older people. Ann Clin Transl Neurol 2024; 11:3095-3102. [PMID: 39440642 DOI: 10.1002/acn3.52216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 08/10/2024] [Accepted: 09/08/2024] [Indexed: 10/25/2024] Open
Abstract
OBJECTIVES Many cases of cervical artery dissection are considered "spontaneous." Recent data suggest that while cervical artery dissection may proportionally explain more strokes in young patients, hospitalization for dissection increases with age, suggesting a potential role of acquired vascular disease. In this study, we hypothesized that traditional vascular risk factors and comorbidities are associated with cervical artery dissection. METHODS We performed a retrospective cohort study using administrative claims data from a 5% sample of Medicare beneficiaries. Exposures of interest included traditional vascular risk factors and comorbidities: coronary artery disease, hyperlipidemia, hypertension, diabetes mellitus, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, valvular heart disease, atrial fibrillation, tobacco use, and alcohol abuse. The primary outcome was a new diagnosis of cervical artery dissection. Marginal structural Cox models were used to characterize the association between the exposures and outcomes, adjusted for time-dependent confounding. RESULTS Among 2,256,710 eligible Medicare beneficiaries, 730 (0.03%) developed cervical artery dissection. The following exposures were found to be significantly associated with the development of cervical artery dissection: hypertension (HR 1.84 [95% CI: 1.40-2.41]), alcohol use (HR 1.83 [1.52-2.21]), atrial fibrillation (HR 1.80 [1.53-2.11]), tobacco use (HR 1.80 [1.52-2.13]), coronary artery disease (HR 1.56 [1.33-1.82]), and valvular heart disease (HR 1.23 [1.05-1.45]). INTERPRETATION In a large cohort of older people, several traditional vascular risk factors and comorbidities were associated with subsequent cervical artery dissection. Further studies exploring the role of such factors in the development of cervical artery dissection are warranted.
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Affiliation(s)
- Joshua Kahan
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Cenai Zhang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Ava L Liberman
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Alan Z Segal
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Santosh B Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Jiwon Kim
- Division of Cardiology, Weill Cornell Medicine, New York, New York, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
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Zimmermann S, Weißenfels M, Krümmer N, Härtig W, Weise G, Branzan D, Michalski D, Pelz JO. Elevated serum levels of anti-collagen type I antibodies in patients with spontaneous cervical artery dissection and ischemic stroke: a prospective multicenter study. Front Immunol 2024; 15:1348430. [PMID: 38840911 PMCID: PMC11150572 DOI: 10.3389/fimmu.2024.1348430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Spontaneous cervical artery dissection (sCAD) is a rare vasculopathy whose trigger is still unknown. We hypothesized that autoimmunity against components of the vascular wall might play a critical role in sCAD and examined anti-collagen type I antibodies in patients with sCAD, acute ischemic stroke, patients with thromboendarterectomy, and controls. Methods Fifty-seven patients with sCAD (age 45.7 ± 10.2 years, female 18 (31.6%)) were prospectively enrolled in four German stroke centers. Blood samples were collected at baseline, at day 10 ± 3, and after 6 ± 1 months. Patients with ischemic stroke not related to CAD (n=54, age 56.7 ± 13.7 years, female 15 (27.8%)), healthy probands (n=80, age 57.4 ± 12.9 years, female 56 (70%)), and patients undergoing thromboendarterectomy of the carotid artery (n=9, age 70.7 ± 9.3 years, female 2 (22.2%)) served as controls. Anti-collagen type I antibodies were determined by enzyme-linked immunosorbent assays (ELISAs). Results Patients with acute sCAD had higher serum levels of anti-collagen type I antibodies (33.9 ± 24.6 µg/ml) than probands (18.5 ± 11.0 µg/ml; p <0.001) but lower levels than patients with ischemic stroke not related to sCAD (47.8 ± 28.4 µg/ml; p=0.003). In patients with sCAD, serum levels of anti-collagen type I antibodies were similar in the acute, subacute, and chronic phase. Levels of anti-collagen type I antibodies significantly correlated with circulating collagen type I (rho=0.207, p=0.003). Conclusion Anti-collagen type I antibodies seem not to represent a trigger for acute sCAD or ischemic stroke but may rather be linked to the metabolism and turnover of collagen type I.
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Affiliation(s)
- Silke Zimmermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | | | - Norma Krümmer
- Department of Neurology, Klinikum Altenburger Land, Altenburg, Germany
| | - Wolfgang Härtig
- Paul Flechsig Institute – Center of Neuropathology and Brain Research, University of Leipzig, Leipzig, Germany
| | - Gesa Weise
- Department of Neurology, Sana Kliniken Leipziger Land, Borna, Germany
| | - Daniela Branzan
- Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Johann Otto Pelz
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
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Long B, Pelletier J, Koyfman A, Bridwell RE. High risk and low prevalence diseases: Spontaneous cervical artery dissection. Am J Emerg Med 2024; 76:55-62. [PMID: 37995524 DOI: 10.1016/j.ajem.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Spontaneous cervical artery dissection (sCAD) is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of sCAD, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION sCAD is a condition affecting the carotid or vertebral arteries and occurs as a result of injury and compromise to the arterial wall layers. The dissection most commonly affects the extracranial vessels but may extend intracranially, resulting in subarachnoid hemorrhage. Patients typically present with symptoms due to compression of local structures, and the presentation depends on the vessel affected. The most common symptom is headache and/or neck pain. Signs and symptoms of ischemia may occur, including transient ischemic attack and stroke. There are a variety of risk factors for sCAD, including underlying connective tissue or vascular disorders, and there may be an inciting event involving minimal trauma to the head or neck. Diagnosis includes imaging, most commonly computed tomography angiography of the head and neck. Ultrasound can diagnose sCAD but should not be used to exclude the condition. Treatment includes specialist consultation (neurology and vascular specialist), consideration of thrombolysis in appropriate patients, symptomatic management, and administration of antithrombotic medications. CONCLUSIONS An understanding of sCAD can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
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Dafer RM, Osteraas ND. Non-atherosclerotic Cerebral Vasculopathies. ISCHEMIC STROKE THERAPEUTICS 2024:271-299. [DOI: 10.1007/978-3-031-49963-0_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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13
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Trager RJ, Daniels CJ, Scott ZE, Perez JA. Pregnancy and spontaneous cervical artery dissection: A propensity-matched retrospective cohort study. J Stroke Cerebrovasc Dis 2023; 32:107384. [PMID: 37742385 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVES We hypothesized that pregnant women would have an increased risk of spontaneous cervical artery dissection (sCeAD) affecting the carotid or vertebral arteries over one-year follow-up after the first trimester ultrasound compared to matched non-pregnant controls. MATERIALS AND METHODS We queried a United States research network (TriNetX, Inc.) of de-identified medical records of >111 million patients, with data spanning 2008-2023. We included women aged ≥18 and excluded those with trauma and conditions potentially causative of sCeAD. Women were divided into cohorts based on a1 first trimester ultrasound and subsequent labor, delivery, or full-term pregnancy, or2 gynecological examination and no pregnancy. We used propensity matching to control for variables associated with sCeAD and calculated the risk ratio (RR) of sCeAD occurring over one-year follow-up from the index date of ultrasound or gynecological exam. RESULTS After matching, the incidence rate of sCeAD in the pregnancy cohort was 8.0 (95% CI: 8.0-8.1) per 100,000 person-years, compared to 3.9 (95% CI: 3.9-3.9) per 100,000 person-years in the non-pregnancy cohort, yielding an RR (95% CI) of 2.06 (1.17-3.61; P= .0104). A cumulative incidence graph suggested that most cases of sCeAD in the pregnancy cohort occurred during pregnancy rather than the postpartum period. CONCLUSIONS Our findings demonstrate that women have a twofold increased risk of sCeAD during pregnancy and the postpartum period compared to non-pregnant women. Further research is needed to determine whether maternal comorbidities such as preeclampsia account for these findings, and clarify when sCeAD occurs in relation to pregnancy or the postpartum period.
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Affiliation(s)
- Robert J Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland OH, USA.
| | - Clinton J Daniels
- Rehabilitation Care Services, VA Puget Sound Health Care System, 9600 Veterans Drive, Tacoma, WA, 98493, USA
| | - Zachary E Scott
- Rehabilitation Care Services, VA Puget Sound Health Care System, 9600 Veterans Drive, Tacoma, WA, 98493, USA
| | - Jaime A Perez
- Clinical Research Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Trager RJ, Cupler ZA, Theodorou EC, Dusek JA. COVID-19 Does Not Increase the Risk of Spontaneous Cervical Artery Dissection. Cureus 2023; 15:e47524. [PMID: 38022016 PMCID: PMC10664733 DOI: 10.7759/cureus.47524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Case reports have raised the possibility of an association between coronavirus disease 2019 (COVID-19) and spontaneous cervical artery dissection (sCeAD), yet no large studies have examined this association. We hypothesized that adults with confirmed COVID-19 would have an increased risk of sCeAD over the subsequent six months compared to test-negative controls after adjusting for confounding variables. Methods We obtained data from a United States medical records network (TriNetX, Inc., Cambridge, MA) of >106 million patients, providing adequate power needed for this rare outcome. We identified two cohorts of adults meeting the criteria of (1) test-confirmed COVID-19 or (2) non-COVID-19 test-negative controls, from April 1, 2020, to December 31, 2022. Patients with previous COVID-19 or conditions predisposing to sCeAD were excluded. Propensity matching was used to control for variables associated with sCeAD and markers of healthcare utilization. Results The number of patients reduced from before matching (COVID-19: 491,592; non-COVID-19: 1,472,895) to after matching, resulting in 491,115 patients per cohort. After matching, there were 22 cases of sCeAD in the COVID-19 cohort (0.0045%) and 20 cases in the non-COVID-19 cohort (0.0041%), yielding a risk ratio of 1.10 (95% CI: 0.60-2.02; P = 0.7576). Both cohorts had a median of five healthcare visits during follow-up. Conclusions Our results suggest that COVID-19 is not a risk factor for sCeAD. This null finding alleviates the concern raised by initial case reports and may better direct future research efforts on this topic.
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Affiliation(s)
- Robert J Trager
- Department of Chiropractic, Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, USA
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, USA
- Department of Biostatistics and Bioinformatics, Clinical Research Training Program, Duke University School of Medicine, Durham, USA
| | - Zachary A Cupler
- Physical Medicine & Rehabilitative Services, Butler VA (Veterans Affairs) Health Care System, Butler, USA
- Institute for Clinical Research Education, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Elainie C Theodorou
- Science Research and Engineering Program, Hathaway Brown School, Cleveland, USA
| | - Jeffery A Dusek
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, USA
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15
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Salehi Omran S. Cervical Artery Dissection. Continuum (Minneap Minn) 2023; 29:540-565. [PMID: 37039409 DOI: 10.1212/con.0000000000001233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Cervical artery dissection is a common cause of stroke in young adults. This article reviews the pathophysiology, etiology and risk factors, evaluation, management, and outcomes of spontaneous cervical artery dissection. LATEST DEVELOPMENTS Cervical artery dissection is believed to be a multifactorial disease, with environmental factors serving as possible triggers in patients who have a genetic predisposition to dissection formation. Cervical artery dissection can cause local symptoms or ischemic events, such as ischemic stroke or transient ischemic attack. Neuroimaging is used to confirm the diagnosis; classic findings include a long tapered arterial stenosis or occlusion, dissecting aneurysm, intimal flap, double lumen, or intramural hematoma. Patients with cervical artery dissection who present with an acute ischemic stroke should be evaluated for IV thrombolysis, endovascular therapy eligibility, or both. Antithrombotic therapy with either anticoagulation or antiplatelet treatment is used to prevent stroke from cervical artery dissection. The risk of recurrent ischemia appears low and is mostly limited to the first two weeks after symptom onset. ESSENTIAL POINTS Cervical artery dissection is a known cause of ischemic strokes. Current data show no difference between the benefits and risks of anticoagulation versus antiplatelet therapy in the acute phase of symptomatic extracranial cervical artery dissection, thereby supporting the recommendation that clinicians can prescribe either treatment. Further research is warranted to better understand the pathophysiology and long-term outcomes of cervical artery dissection.
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Keser Z, Chiang CC, Benson JC, Pezzini A, Lanzino G. Cervical Artery Dissections: Etiopathogenesis and Management. Vasc Health Risk Manag 2022; 18:685-700. [PMID: 36082197 PMCID: PMC9447449 DOI: 10.2147/vhrm.s362844] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Cervical Artery Dissection (CeAD) is a frequent stroke etiology for patients younger than 50 years old. The most common immediate complications related to CeAD are headache and neck pain (65-95%), TIA/ischemic stroke (>50%), and partial Horner's syndrome (25%). The prevailing hypothesis regarding the pathogenesis of sCeAD is that the underlying constitutional vessel wall weakness of patients with sCeAD is genetically determined and that environmental factors could act as triggers. The stroke prevention treatment of CeAD remains controversial, involving anticoagulation or antiplatelet therapy and potentially emergent stenting and/or thrombectomy or angioplasty for selected cases of carotid artery dissection with occlusion. The treatment of headache associated with CeAD depends on the headache phenotype and comorbidities. Radiographically, more than 75% of CeAD cases present with occlusion or non-occlusive stenosis. Many patients demonstrate partial and complete healing, more commonly in the carotid arteries. One-fifth of the patients develop dissecting pseudoaneurysm, but this is a benign clinical entity with an extremely low rupture and stroke recurrence risk. Good recovery is achieved in many CeAD cases, and mortality remains low. Family history of CeAD, connective tissue disorders like Ehlers-Danlos syndrome type IV, and fibromuscular dysplasia are risk factors for recurrent CeAD, which can occur in 3-9% of the cases. This review serves as a comprehensive, updated overview of CeAD, emphasizing etiopathogenesis and management.
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Affiliation(s)
- Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
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Arning C, Hanke-Arning K, Eckert B. The Clinical Features of Dissection of the Cervical Brain-Supplying Arteries. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:581-587. [PMID: 35734920 PMCID: PMC9749844 DOI: 10.3238/arztebl.m2022.0238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/04/2022] [Accepted: 05/17/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Dissections of the cervical brain-supplying arteries are a leading cause of ischemic stroke in young adults, with an annual incidence of 2.5-3 / 100 000 for carotid artery dissection and 1-1.5 / 100 000 for vertebral artery dissection. It can be assumed that many cases go unreported. We present the clinical features here to help physicians diagnose this disease entity as rapidly as possible. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed. RESULTS Spontaneous dissection of the internal carotid or vertebral artery is characterized by a hematoma in the vessel wall. It often arises in connection with minor injuries; underlying weakness of the arterial wall (possibly only temporary) may be a predisposing factor. Acute unilateral pain is the main presenting symptom. In internal carotid dissection, the site of the pain is temporal in 46% of cases, and frontal in 19%; in vertebral artery dissection, it is nuchal and occipital in 80%. Pain and local findings, such as Horner syndrome, are generally present from the beginning, while stroke may arise only after a latency of hours to days. If the diagnosis is made early with MRI, CT, or ultrasound, and anticoagulation or antiplatelet drugs can help prevent a stroke, yet none of these methods can detect all cases. Recurrent dissection is rare, except in patients with connective tissue diseases such as Ehlers-Danlos syndrome or fibromuscular dysplasia. Spontaneous dissection of the great vessels of the neck must be differentiated from aortic dissection spreading to the supra-aortic vessels and from traumatic dissection due to blunt or penetrating vascular trauma. CONCLUSION Dissection of the cervical brain-supplying vessels is not always revealed by the imaging methods that are used to detect it. Stroke prevention thus depends on the physician's being aware of the symptoms and signs of this disease entity, so that early diagnosis can be followed by appropriate treatment.
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Affiliation(s)
- Christian Arning
- Praxis Neurologie und Neuro-Ultraschall, Hamburg,*Facharzt für Neurologie und Psychiatrie Moorhof 2d, D-22399 Hamburg, Germany
| | | | - Bernd Eckert
- Department of Neuroradiology, Asklepios Klinik Altona, Hamburg
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Guida A, Tortora F, Tortora M, Buono G, Marseglia M, Tarantino M, Rizzuti M, Loiudice G, Manganelli F, Briganti F. Dissective tandem stroke: an endovascular approach. Radiol Case Rep 2022; 17:2170-2174. [PMID: 35479967 PMCID: PMC9035657 DOI: 10.1016/j.radcr.2022.03.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/20/2022] Open
Abstract
Ischemic stroke due to internal carotid artery occlusion is a potential devastating condition. More frequently the occlusions are embolic in nature, but sometimes they are caused by arterial dissection and their treatment is a challenge. We describe an illustrative case where a young patient with middle cerebral artery stroke caused by carotid artery dissection was submitted to endovascular treatment of mechanical thrombectomy and stenting, giving an excellent outcome. We believe that tandem approach is a treatment of choice in these cases.
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Affiliation(s)
- Amedeo Guida
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
- Corresponding author.
| | - Fabio Tortora
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Mario Tortora
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Giuseppe Buono
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Mariano Marseglia
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Margherita Tarantino
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Michele Rizzuti
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Giovanni Loiudice
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience and Reproductive Sciences and Dentistry, University “Federico II”, Naples, Italy
| | - Francesco Briganti
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University “Federico II”, Naples, Italy
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Reading J, Bhatt R, Kilbey L, Breene R, Hall G, Kavirayani A, Joseph R, Ramdas S. Double Trouble: Stroke in a Child with Down's Syndrome. JOURNAL OF PEDIATRIC NEUROLOGY 2022. [DOI: 10.1055/s-0042-1742688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractDown's syndrome (trisomy 21) is well recognized to be associated with several autoimmune conditions such as hypothyroidism, celiac disease, and diabetes mellitus. Antiphospholipid syndrome (APS), an immune disorder, can cause a stroke due to the prothrombotic state. APS is associated with several autoimmune diseases including systemic lupus erythematosus, rheumatoid arthritis, and systemic vasculitis, as well as Down's syndrome. Down's syndrome is linked to several other risk factors for stroke including congenital heart disease, moyamoya disease, and arterial dissection. We present the case of a 3-year-old girl child patient with Down's syndrome, who presented with an acute arterial ischemic stroke secondary to carotid artery dissection and subsequently was also confirmed to have APS. We review the literature on Down's syndrome and APS, the proposed pathophysiology, and management strategies. We present a case of a 3-year-old girl with Down's syndrome and who presented with stroke, review previously published cases, and discuss the conditions and their management. Autoimmune conditions, such as antiphospholipid syndrome, are more common in individuals with Down's syndrome, and as such should be investigated when these children present with symptoms suggestive of stroke.
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Affiliation(s)
- Jacob Reading
- Department of Pediatrics, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Ree'Thee Bhatt
- Department of Pediatrics, Milton Keynes University Hospital National Health Service Foundation Trust, Milton Keynes, United Kingdom
| | - Laura Kilbey
- Department of Pediatrics, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Richard Breene
- Department of Pediatrics, Northampton General Hospital National Health Service Trust, Northampton, United Kingdom
| | - Georgina Hall
- Department of Pediatric Hematology, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Akhila Kavirayani
- Department of Pediatric Rheumatology, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Robin Joseph
- Department of Radiology, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Sithara Ramdas
- Department of Pediatric Neurology, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
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Tarsia J, Vidal G, Zweifler RM. Arterial Dissection, Fibromuscular Dysplasia, and Carotid Webs. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Venturini G, Vuolo L, Pracucci G, Picchioni A, Failli Y, Benvenuti F, Sarti C. Association between carotid artery dissection and vascular tortuosity: a case-control study. Neuroradiology 2021; 64:1127-1134. [PMID: 34766191 DOI: 10.1007/s00234-021-02848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We aimed to verify if vascular tortuosity (VT) may represent a risk factor for spontaneous epiaortic vessel dissection (sEVD) in young adult patients. METHODS We identified 304 patients aged under 55 years consecutively admitted for acute cerebrovascular events to our Stroke Unit. After checking the possibility to perform a 3D reconstruction of epiaortic vessels on CT-angiography images, we selected and compared fifty patients with sEVD (cases) with fifty-one patients without dissection (controls). VT of carotid and vertebral arteries was measured on reconstructions evaluating the vascular tortuosity index (VTI), calculated according to a specific algorithm, and the presence of kinking and coiling. Differences between groups were analyzed by Student-t test for numeric variables and chi-square test for categoric ones. A ROC curve analysis was used to look for a VTI threshold value beyond which the risk of dissection was significantly increased. RESULTS VTI was significantly higher in cases than in controls only considering carotid arteries (p = 0.029); cases did not have a significantly higher rate of kinking and coiling than controls (p = 0.059 and 0.077, respectively). We have found a significant VTI threshold value of 27.9% (under curve area = 61.6%, p = 0.04) only for carotid artery dissection. CONCLUSION VT appears to be associated with an increased risk of dissection for the carotid district but not for the vertebral one. The different structure, embryogenesis, and pathophysiology of dissection between the two districts could explain this finding. VTI threshold as carotid artery dissection predictor deserves confirmation in larger studies.
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Affiliation(s)
- Gabriele Venturini
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Luisa Vuolo
- Neuroradiology Unit, Careggi University Hospital, Largo Piero Palagi, 1, 50139, Florence, Italy
| | - Giovanni Pracucci
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Antonella Picchioni
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Ylenia Failli
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Federica Benvenuti
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy
| | - Cristina Sarti
- NEUROFARBA Department, University of Florence, Viale Pieraccini, 6, 50139, Florence, Italy.
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Williams L, Delaney F, Kenny G, Marnane M, Kavanagh E, Sheehan G, Murphy S. Varicella-Zoster Vasculopathy Causing Carotid Artery Dissection. Neurol Clin Pract 2021; 11:e373-e375. [PMID: 34484920 DOI: 10.1212/cpj.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/04/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Laura Williams
- Department of Neurology (LW, MM), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Radiology (FD, EK), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Stroke Medicine (GK, SM), Mater Misericordiae University Hospital, Dublin, Ireland; and Department of Infectious Diseases (GS), Mater Misericordiaae University Hospital, Dublin, Ireland
| | - Francis Delaney
- Department of Neurology (LW, MM), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Radiology (FD, EK), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Stroke Medicine (GK, SM), Mater Misericordiae University Hospital, Dublin, Ireland; and Department of Infectious Diseases (GS), Mater Misericordiaae University Hospital, Dublin, Ireland
| | - Grace Kenny
- Department of Neurology (LW, MM), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Radiology (FD, EK), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Stroke Medicine (GK, SM), Mater Misericordiae University Hospital, Dublin, Ireland; and Department of Infectious Diseases (GS), Mater Misericordiaae University Hospital, Dublin, Ireland
| | - Michael Marnane
- Department of Neurology (LW, MM), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Radiology (FD, EK), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Stroke Medicine (GK, SM), Mater Misericordiae University Hospital, Dublin, Ireland; and Department of Infectious Diseases (GS), Mater Misericordiaae University Hospital, Dublin, Ireland
| | - Eoin Kavanagh
- Department of Neurology (LW, MM), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Radiology (FD, EK), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Stroke Medicine (GK, SM), Mater Misericordiae University Hospital, Dublin, Ireland; and Department of Infectious Diseases (GS), Mater Misericordiaae University Hospital, Dublin, Ireland
| | - Gerald Sheehan
- Department of Neurology (LW, MM), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Radiology (FD, EK), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Stroke Medicine (GK, SM), Mater Misericordiae University Hospital, Dublin, Ireland; and Department of Infectious Diseases (GS), Mater Misericordiaae University Hospital, Dublin, Ireland
| | - Séan Murphy
- Department of Neurology (LW, MM), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Radiology (FD, EK), Mater Misericordiae University Hospital, Dublin, Ireland; Department of Stroke Medicine (GK, SM), Mater Misericordiae University Hospital, Dublin, Ireland; and Department of Infectious Diseases (GS), Mater Misericordiaae University Hospital, Dublin, Ireland
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24
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Progressive triple cervical artery dissection in association with upper respiratory tract infection. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hunter MD, Moon YP, Miller EC, Kulick ER, Boehme AK, Elkind MS. Influenza-Like Illness is Associated with Increased Short-Term Risk of Cervical Artery Dissection. J Stroke Cerebrovasc Dis 2021; 30:105490. [PMID: 33253984 PMCID: PMC10086675 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Non-traumatic Cervical Artery Dissection (CeAD) is a leading cause of ischemic stroke in the young. Influenza-like illnesses (ILI) trigger ischemic strokes. We hypothesized that influenza and ILI are associated with CeAD. METHODS In a case-crossover study within the New York State (NYS) Department of Health Statewide Planning and Research Cooperative System (2006-2014), we used ICD-9 codes to exclude major trauma and to define CeAD, influenza, and the Centers for Disease Control defined ILI. We estimated the association of ILI and influenza with CeAD by comparing their prevalence in intervals immediately prior (0-30,0-90,0-180, and 0-365 days) to CeAD (case period) to their prevalence exactly one and two years earlier (control periods). Conditional logistic regression models generated odds ratios and 95% confidence intervals (OR, 95% CI). Models were adjusted for NYS estimates of influenza prevalence rates. RESULTS Our sample included 3,610 cases of CeAD (mean age 52±16 years, 54.7% male, 6.2% Hispanic, 9.9% Black, 68.7% White). During case periods, 7.3% had one or more ILI. ILI was more likely within 90 days of CeAD compared to the same time interval one and two years before (0-15 days: adjusted OR 1.88, 95%CI 1.20-2.94; 0-30 days: adjusted OR 1.74, 95%CI 1.22-2.46; 0-90 days: adjusted OR 1.35, 95%CI 1.00-1.81). Influenza trended with CeAD (adjusted OR 1.86, 95%CI 0.37-9.24), but these results were not statistically significant, due to limited instances of confirmed influenza. CONCLUSIONS ILI may increase risk of CeAD for 15 days, and possibly up to three months.
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Affiliation(s)
- Madeleine D Hunter
- Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA.
| | - Yeseon P Moon
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA.
| | - Eliza C Miller
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA.
| | - Erin R Kulick
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA.
| | - Amelia K Boehme
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA.
| | - Mitchell Sv Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA; Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA.
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26
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Asan L, Deuschl C, Forsting M, Kleinschnitz C, Köhrmann M. Oropharyngeal swab for SARS-CoV-2 test causing atypical internal carotid artery dissection and stroke in a patient after mild COVID-19. Ther Adv Neurol Disord 2021; 14:17562864211033521. [PMID: 35173807 PMCID: PMC8842151 DOI: 10.1177/17562864211033521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/30/2021] [Indexed: 11/21/2022] Open
Abstract
We report a patient who had recovered from pneumonia caused by severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) presenting with acute cerebral ischemia due to
atypical dissection of the left internal carotid artery immediately after an oropharyngeal
swab (OPS) for SARS-CoV-2 RT-PCR testing. The symptoms consisting of right-side
hemiparesis and aphasia improved after systemic thrombolysis and the patient recovered
completely in the further course. We demonstrate findings from imaging (computed
tomography, magnetic resonance imaging, neurovascular ultrasound) among other
investigations and discuss coronavirus disease 2019 (COVID-19)-related vessel wall
vulnerability as well as tissue injury posed by the swab procedure as underlying causes of
the dissection. Individuals performing OPSs during the corona pandemic should be aware of
this so far undescribed complication.
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Affiliation(s)
- Livia Asan
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Hufelandstr. 55, Essen, 45147, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, Essen, Germany
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27
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Sun G, Yang Y, Chen Z, Yang L, Diao S, Huang S, Wang Y, Wang Y, Sun B, Yuan X, Xu X. Neutrophil to Lymphocyte Ratio Predicts Outcome of Stroke by Cervicocranial Arterial Dissection. Front Med (Lausanne) 2020; 7:598055. [PMID: 33330561 PMCID: PMC7729127 DOI: 10.3389/fmed.2020.598055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose: Neutrophil to lymphocyte ratio (NLR) is positively associated with poor prognosis in patients with cerebral infarction. The goal of this prospective study is to explore the predictive value of NLR in patients with acute ischemic stroke (AIS) caused by cervicocranial arterial dissection (CCAD). Methods: Ninety-nine patients with AIS caused by CCAD met criteria for inclusion and exclusion were selected for this study. We collected baseline data on the admission including NLR. The primary poor outcome was major disability (modified Rankin Scale score ≥ 3) or death at 3 months after AIS. Results: A total of 20 (20.2%) patients had a poor outcome at 3 months after AIS. According to the 3-month outcome, the patients were divided into two groups and univariate and multivariable analyses were conducted. Among the risk factors, elevated NLR levels were independently associated with 3-month poor outcomes. Further, we made the ROC curve to evaluate the predictive value of NLR level on prognosis. The area under the curve was 0.79 and a cut-off value of NLR was 2.97 for differentiating the poor outcome. We divided patients into groups according to the cut-off value. Patients with high NLR have a higher risk of poor outcome than those with low NLR (P < 0.05). Conclusion: As an inflammatory marker, elevated NLR levels were associated with 3-month poor outcome in AIS caused by CCAD.
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Affiliation(s)
- Guangbi Sun
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Yang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhiguo Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Le Yang
- School of Public Health, Fujian Medical University, Fuzhou, China
| | - Shanshan Diao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shicun Huang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiqing Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiting Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Baoliang Sun
- Department of Neurology, The Second Affiliated Hospital, Shandong Academy of Medical Sciences, Shandong First Medical University, Taian, China
| | - Xia Yuan
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xingshun Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China.,The Institute of Neuroscience, Soochow University, Suzhou, China
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28
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Tai MLS, Sia SF, Kadir KAA, Idris MI, Tan KS. Cough-Induced Extracranial Internal Carotid Artery Dissection. Case Rep Neurol 2020; 12:149-155. [PMID: 33505287 DOI: 10.1159/000501069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/16/2019] [Indexed: 11/19/2022] Open
Abstract
Background Coughing due to respiratory tract infections may lead to internal carotid artery (ICA) dissection. Aim We are presenting a patient with an unusual cough-induced ICA dissection. Case Report A 42-year-old health care worker presented with bilateral hand numbness which resolved spontaneously. This initial episode was followed 9 days later with intermittent episodes of right hand and leg weakness with speech difficulty. Two days later, he had another episode of speech difficulty. One week prior to the first presentation, he had upper respiratory tract infection with ongoing strong bouts of coughing. Magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) of the brain showed early ischaemic changes at the left frontal and left parietal regions. MR angiography (MRA) showed high signal intensity at the left proximal ICA and poor flow beyond the left carotid bulb. Cerebral angiography revealed left ICA dissection. Conclusion Proper identification of cough-induced extracranial ICA dissection is important because this is treatable.
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Affiliation(s)
- Mei-Ling Sharon Tai
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sheau Fung Sia
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khairul Azmi Abdul Kadir
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohamad Imran Idris
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kay Sin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Qiu FQ, Li CC, Zhou JY. Hemorrhagic fever with renal syndrome complicated with aortic dissection: A case report. World J Clin Cases 2020; 8:5795-5801. [PMID: 33344576 PMCID: PMC7716303 DOI: 10.12998/wjcc.v8.i22.5795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/13/2020] [Accepted: 09/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hemorrhagic fever with renal syndrome is caused by hantaviruses presenting with high fever, hemorrhage, and acute kidney injury. Microvascular injury and hemorrhage in mucus were often observed in patients with hantavirus infection. Infection with bacterial and virus related aortic aneurysm or dissection occurs sporadically. Here, we report a previously unreported case of hemorrhagic fever with concurrent aortic dissection.
CASE SUMMARY A 56-year-old man complained of high fever and generalized body ache, with decreased platelet counts of 10 × 109/L and acute kidney injury. The enzyme-linked immunosorbent assays test for immunoglobulin M and immunoglobulin G hantavirus-specific antibodies were both positive. During the convalescent period, he complained sudden onset acute chest pain radiating to the back, and the computed tomography angiography revealed an aortic dissection of the descending aorta extending to iliac artery. He was diagnosed with hemorrhagic fever with renal syndrome and Stanford B aortic dissection. The patient recovered completely after surgery with other support treatments.
CONCLUSION Hemorrhagic fever with renal syndrome complicated with aortic dissection is rare and a difficult clinical condition. Hantavirus infection not only causes microvascular damage presenting with hemorrhage but may be risk factor for acute macrovascular detriment. A causal relationship has yet to be confirmed.
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Affiliation(s)
- Feng-Qi Qiu
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Cong-Cong Li
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
| | - Jian-Ya Zhou
- Department of Respiratory Disease, Thoracic Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, Zhejiang Province, China
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30
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Shivakumar N, Rajagopal R, Norris JH, Martinez-Devesa P. Non-Traumatic Carotid Artery Dissection Following an Episode of Orbital Cellulitis: A Case Report. Cureus 2020; 12:e11175. [PMID: 33262912 PMCID: PMC7689807 DOI: 10.7759/cureus.11175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Carotid artery dissection (CAD) is a haemorrhage into the arterial wall disrupting the intimal layers of the vessel. We present a case of a 16-year-old male with a non-traumatic spontaneous CAD. The patient presented with Horner's syndrome following an episode of orbital cellulitis secondary to sinusitis requiring sinus drainage surgery. Subsequent magnetic resonance imaging (MRI) revealed a CAD. The patient was treated with antiplatelet medication.
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Affiliation(s)
- Natesh Shivakumar
- Otolaryngology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
| | - Rajini Rajagopal
- Otolaryngology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
| | - Jonathan H Norris
- Ophthalmology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
| | - Pablo Martinez-Devesa
- Otolaryngology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, GBR
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31
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Katsi V, Antoniou CK, Manolakou P, Toutouzas K, Tousoulis D. What's in a prick? Vaccines and the cardiovascular system. Hellenic J Cardiol 2020; 61:233-240. [PMID: 31740362 DOI: 10.1016/j.hjc.2019.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/22/2019] [Accepted: 09/28/2019] [Indexed: 12/24/2022] Open
Abstract
Evidence suggests a crucial role for vaccines in cardiovascular disease, mediated not only by disease prevention but also by immunomodulatory effects. This review attempts to briefly present the effects of pathogens and vaccines on the cardiovascular system and potential mechanisms for the development of vaccines against cardiovascular diseases per se. Current epidemiological evidence regarding vaccine effectiveness in different categories of heart disease is discussed, as well as current international guidelines' recommendations. In summary, cardiologists should strive to promote vaccination against specific pathogens with proven beneficial effects on cardiovascular diseases.
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Affiliation(s)
- Vasiliki Katsi
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, Athens, Greece
| | | | - Panagiota Manolakou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, Athens, Greece
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32
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Rodríguez-Castro E, Mosqueira AJ, Santamaría-Cadavid M, Arias-Rivas S. [Progressive triple dissection of the cervical arteries in association with upper respiratory tract infection]. Neurologia 2020; 36:177-179. [PMID: 32565038 DOI: 10.1016/j.nrl.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/20/2019] [Accepted: 12/14/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Rodríguez-Castro
- Unidad de Ictus, Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España.
| | - A J Mosqueira
- Unidad de Neurorradiología, Servicio de Radiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - M Santamaría-Cadavid
- Unidad de Ictus, Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - S Arias-Rivas
- Unidad de Ictus, Servicio de Neurología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
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Morassi M, Bigni B, Cobelli M, Giudice L, Bnà C, Vogrig A. Bilateral carotid artery dissection in a SARS-CoV-2 infected patient: causality or coincidence? J Neurol 2020; 267:2812-2814. [PMID: 32533323 PMCID: PMC7292240 DOI: 10.1007/s00415-020-09984-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Mauro Morassi
- Department of Diagnostic Imaging, Unit of Neuroradiology, Fondazione Poliambulanza Istituto Ospedaliero, Via L. Bissolati 57, 25124, Brescia, Italy.
| | - Barbara Bigni
- Head and Neck Department, Unit of Neurology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Milena Cobelli
- Department of Diagnostic Imaging, Unit of Neuroradiology, Fondazione Poliambulanza Istituto Ospedaliero, Via L. Bissolati 57, 25124, Brescia, Italy
| | - Lodoviga Giudice
- Head and Neck Department, Unit of Neurosurgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Claudio Bnà
- Department of Diagnostic Imaging, Unit of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Alberto Vogrig
- Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero, Santa Maria della Misericordia, Udine, Italy
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Abstract
PURPOSE OF REVIEW Although the clinical approach to the young adult stroke patient is similar to that of an older adult, several important differences exist. The purpose of this article is to concisely review the epidemiology, pathophysiology, risk factors, clinical manifestations, diagnostic methods and current treatment options for the young adult ischemic stroke patient. RECENT FINDINGS Evidence clearly indicates that the incidence ischemic stroke in young adults is on the rise. A variety of factors are implicated, including an increased burden of classic and emerging vascular risk factors, and improved stroke detection, among other causes. Improved awareness, prevention and successful treatment of the young adult stroke patient is of great importance, particularly given the major long-term socioeconomic impact strokes have on the patient, their family and society at large. SUMMARY In this review, we focus on the latest epidemiologic, diagnostic and treatment paradigms to improve physician awareness and optimize outcomes in young adult ischemic stroke patients. An overview of the clinical presentations of various stroke syndromes is described, emphasizing key causes physicians should consider, as well as providing recommendations regarding evaluation and treatment. Important causes including dissection and inflammatory and noninflammatory vasculopathies are emphasized. The diagnoses of cerebral venous thromboses, cardioembolic stroke and paradoxical emboli are also discussed. The effects of established and emerging risk factors on large and small vessel disease, as well as genetic contributions, are also highlighted.
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35
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Bakradze E, Kirchoff KF, Antoniello D, Springer MV, Mabie PC, Esenwa CC, Labovitz DL, Liberman AL. Varicella Zoster Virus Vasculitis and Adult Cerebrovascular Disease. Neurohospitalist 2019; 9:203-208. [PMID: 31534609 PMCID: PMC6739663 DOI: 10.1177/1941874419845732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The role of Varicella zoster virus (VZV) in neurological illness, particularly cerebrovascular disease, has been increasingly recognized. Primary infection by VZV causes varicella (chickenpox), after which the virus remains latent in neuronal ganglia. Later, during aging or immunosuppression, the virus can reactivate causing zoster (shingles). Virus reactivation can also spread to cerebral arteries causing vasculitis and stroke. Zoster is a recognized risk factor for stroke, but stroke can occur without preceding zoster rash. The diagnosis of VZV cerebral vasculitis is established by abnormal brain imaging and confirmed by presence of viral DNA or anti-VZV antibodies in cerebrospinal fluid. Treatment with acyclovir with or without prednisone is usually recommended. VZV vasculitis is a unique and uncommon stroke mechanism that has been under recognized. Careful diagnostic investigation may be warranted in a subgroup of patients with ischemic stroke to detect VZV vasculitis and initiate appropriate therapy. In the following review, we detail the clinical presentation of VZV vasculitis, diagnostic challenges in VZV detection, and suggest the ways to enhance recognition and treatment of this uncommon disease.
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Affiliation(s)
- Ekaterina Bakradze
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn F. Kirchoff
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Antoniello
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Peter C. Mabie
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neurology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Charles C. Esenwa
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel L. Labovitz
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ava L. Liberman
- Saul R. Korey Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Chen WT, Chang FC, Huang HC, Tsai JY, Chung CP. Total and differential leukocyte counts in ischemic stroke caused by vertebrobasilar artery dissection. J Neurol Sci 2019; 404:101-105. [PMID: 31352292 DOI: 10.1016/j.jns.2019.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/21/2019] [Accepted: 07/17/2019] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Vertebrobasilar artery dissection(VBD) is a common etiology of posterior circulation stroke(PCS). However, the etiology of VBD itself remains unclear. The present study aimed to test whether inflammation is involved in the mechanism of VBD by evaluating its relationship with total and differential leukocyte counts. METHODS Patients with PCS caused by VBD or by large artery atherosclerosis(LAA) were recruited between January 1, 2012 and December 31, 2014 from the Taipei Veterans General Hospital. Age- and sex-matched non-stroke(NS) volunteers were also included. Univariate and multivariate analyses were performed to compare total/differential leukocyte counts among VBD, LAA, and NS groups. RESULTS One-hundred-one patients with VBD [average age: 64.8(15.1) years; 77(76.2%) males], 70 with LAA [average age: 73.9(10.6) years; 44(62.9%) males], and 202 NS [average age: 64.8(15.1) years; 77(76.2%) males] patients were included in the present study. Compared with the NS and LAA groups, respectively, the VBD group had significantly higher total leukocyte and neutrophil counts and frequency of high leukocyte (>10,000 × 106/L) and high neutrophil (>8000 × 106/L) counts. Multivariate analyses, adjusted for age, sex, and vascular risk factors, showed that the VBD group, compared with the other groups, had an odds-ratio of 5.04 (95% confidence interval:2.43-10.43) and 5.90 (2.70-12.92) with respect to the prevalence of high leukocyte and high neutrophil counts. CONCLUSION VBD was associated with high leukocyte and neutrophil counts. Our results support that inflammation and neutrophil-related pathophysiology might be involved in the mechanism of VBD; however, the causal relationship would need further investigations.
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Affiliation(s)
- Wan-Ting Chen
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Chi Chang
- Department Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hui-Chi Huang
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jui-Yao Tsai
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Ping Chung
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan.
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Pashaei-Marandi A, Kini A, Al Othman B, Lee AG, Falardeau J. The sign of the cross. Surv Ophthalmol 2019; 66:145-148. [PMID: 31129261 DOI: 10.1016/j.survophthal.2019.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
Acute, painful, transient, right-sided, monocular visual loss lasting 4 hours developed in a 46-year-old man. This was followed by headache and left-sided transient hemiparesis. The association of ipsilateral transient vision loss with transient contralateral hemiparesis implicates involvement of the ipsilateral internal carotid artery (i.e., a crossed symptom).
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Affiliation(s)
| | - Ashwini Kini
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Bayan Al Othman
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, USA.
| | - Julie Falardeau
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
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38
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Coburn JA, Golden E, Brucker J, Kennedy TA. Nontraumatic Vascular Emergencies of the Neck. Semin Ultrasound CT MR 2019; 40:157-171. [PMID: 31030739 DOI: 10.1053/j.sult.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nontraumatic vascular emergencies of the head and neck are uncommon, but can occur in patients with central venous catheters, head and neck infections, and in patients with head and neck cancer. Recognizing the imaging findings of vascular complications in these patient populations is critically important to ensure expeditious treatment to avoid significant morbidity and mortality.
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Affiliation(s)
- John A Coburn
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Edwarda Golden
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Justin Brucker
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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McCrea N, Fullerton HJ, Ganesan V. Genetic and Environmental Associations With Pediatric Cerebral Arteriopathy. Stroke 2019; 50:257-265. [DOI: 10.1161/strokeaha.118.020479] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Nadine McCrea
- From the Department of Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London (N.M.)
| | | | - Vijeya Ganesan
- Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London (V.G.)
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40
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Mélé N, Turc G. Stroke Associated With Recent Mycoplasma Pneumoniae Infection: A Systematic Review of Clinical Features and Presumed Pathophysiological Mechanisms. Front Neurol 2018; 9:1109. [PMID: 30622505 PMCID: PMC6308181 DOI: 10.3389/fneur.2018.01109] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 12/04/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: An association between Mycoplasma pneumoniae (MP) infection and stroke has been described, especially in children. However, current knowledge on this rare potential cause of stroke is scant. The purpose of this systematic review of all published cases was to help better understand the relationships between recent MP infection and ischemic stroke on a clinical, radiological and pathophysiological perspective. Material and Methods: A PubMed and Embase search was performed in September 2018 to identify all published cases of stroke occurring within 4 weeks after MP infection. Results: Twenty-eight patients with ischemic stroke associated with MP infection were identified. Median age was 8 years (range: neonate to 57). The middle cerebral artery territory was involved in 25 (89%) patients. Fifteen (54%) patients had at least one arterial occlusion. Elevated D-dimer and/or fibrinogen was reported in 8 (29%) patients. Four patients had transient anticardiolipin IgM antibodies. Cerebrospinal fluid analysis showed pleocytosis in 7/20 (35%) patients (median: 19 leucocytes/μL, range: 10 to 63) and MP PCR was positive in 3/8 (38%) patients. The etiological work-up was considered inconclusive in 25 (89%) patients. Three (11%) patients died during follow-up, all of early respiratory deterioration. Neurological functional outcome was good in 22/27 (81%) patients. Conclusion: The association between MP infection and ischemic stroke in children and young adults is rare. Underlying pathogenesis might include hypercoagulability and vasculitis. Most patients achieve a favorable recovery. Whether MP infection could be a long-term risk factor for stroke by promoting atherosclerosis is uncertain and deserves further investigation.
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Affiliation(s)
- Nicolas Mélé
- Service de Neurologie, Centre Hospitalier Sainte-Anne, Paris, France
- Université Paris Descartes, Paris, France
- INSERM UMR 894, Paris, France
- DHU Neurovasc, Paris, France
| | - Guillaume Turc
- Service de Neurologie, Centre Hospitalier Sainte-Anne, Paris, France
- Université Paris Descartes, Paris, France
- INSERM UMR 894, Paris, France
- DHU Neurovasc, Paris, France
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Compter A, Schilling S, Vaineau CJ, Goeggel-Simonetti B, Metso TM, Southerland A, Pezzini A, Kloss M, Touzé E, Worrall BB, Thijs V, Bejot Y, Reiner P, Grond-Ginsbach C, Bersano A, Brandt T, Caso V, Lyrer PA, Traenka C, Lichy C, Martin JJ, Leys D, Sarikaya H, Baumgartner RW, Jung S, Fischer U, Engelter ST, Dallongeville J, Chabriat H, Tatlisumak T, Bousser MG, Arnold M, Debette S. Determinants and outcome of multiple and early recurrent cervical artery dissections. Neurology 2018; 91:e769-e780. [DOI: 10.1212/wnl.0000000000006037] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/21/2018] [Indexed: 01/25/2023] Open
Abstract
ObjectiveTo assess putative risk factors and outcome of multiple and early recurrent cervical artery dissection (CeAD).MethodsWe combined data from 2 multicenter cohorts and compared patients with multiple CeAD at initial diagnosis, early recurrent CeAD within 3 to 6 months, and single nonrecurrent CeAD. Putative risk factors, clinical characteristics, functional outcome, and risk of recurrent ischemic events were assessed.ResultsOf 1,958 patients with CeAD (mean ± SD age 44.3 ± 10 years, 43.9% women), 1,588 (81.1%) had single nonrecurrent CeAD, 340 (17.4%) had multiple CeAD, and 30 (1.5%) presented with single CeAD at admission and had early recurrent CeAD. Patients with multiple or early recurrent CeAD did not significantly differ with respect to putative risk factors, clinical presentation, and outcome. In multivariable analyses, patients with multiple or early recurrent CeAD more often had recent infection (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.29–2.53), vertebral artery dissection (OR 1.82, 95% CI 1.34–2.46), family history of stroke (OR 1.55, 95% CI 1.06–2.25), cervical pain (OR 1.36, 95% CI 1.01–1.84), and subarachnoid hemorrhage (OR 2.85, 95% CI 1.01–8.04) at initial presentation compared to patients with single nonrecurrent CeAD. Patients with multiple or early recurrent CeAD also had a higher incidence of cerebral ischemia (hazard ratio 2.77, 95% CI 1.49–5.14) at 3 to 6 months but no difference in functional outcome compared to patients with single nonrecurrent CeAD.ConclusionPatients with multiple and early recurrent CeAD share similar risk factors, clinical characteristics, and functional outcome. Compared to patients with single nonrecurrent CeAD, they are more likely to have recurrent cerebral ischemia at 3 to 6 months, possibly reflecting an underlying transient vasculopathy.
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Demetrious JS. Spontaneous cervical artery dissection: a fluoroquinolone induced connective tissue disorder? Chiropr Man Therap 2018; 26:22. [PMID: 30002812 PMCID: PMC6036697 DOI: 10.1186/s12998-018-0193-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/01/2018] [Indexed: 11/12/2022] Open
Abstract
Background Spontaneous cervical artery dissections more often manifest in young people and have been associated with catastrophic consequences. Some indeterminate risk factors have been identified, making the diagnosis of developing dissections quite difficult. Fluoroquinolone antibiotics have been recognized for their degradative effects on connective tissue. Recent studies have implicated fluoroquinolones in the genesis of aortic artery aneurysms. It is the purpose of this paper to provide reasoning for a testable hypothesis of whether fluoroquinolones constitute a risk factor associated with cervical artery dissections. Methods A PubMed search was conducted to investigate whether cervical artery dissection has been associated with fluoroquinolone use. An assessment of risk factors was made of hereditary connective tissue disorders, infection, and seasonal predisposition related to cervical artery dissection. These factors were considered in conjunction with reports of connective tissue toxicity associated with fluoroquinolone medications. Results It appears that no reported cases of cervical artery dissection have previously been correlated with fluoroquinolone use. Heritable connective tissue disorders, infection, seasonal predisposition and condition latencies are associated with fluoroquinolone medications. Several recent articles have implicated fluoroquinolones with aortic dissections and aneurysm. Conclusion A causal relationship of fluoroquinolone antibiotics to cervical artery dissection is plausible. The suppositions developed in this paper are insufficient to suggest that fluoroquinolones currently represent an established risk factor in the development of cervical artery dissections. Fluoroquinolones may indeed be a novel and previously unrecognized cause of cervical artery dissections.
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Turner RC, Lucke-Wold BP, Boo S, Rosen CL, Sedney CL. The potential dangers of neck manipulation & risk for dissection and devastating stroke: An illustrative case & review of the literature. BIOMEDICAL RESEARCH AND REVIEWS 2018; 2:10.15761/BRR.1000110. [PMID: 29951644 PMCID: PMC6016850 DOI: 10.15761/brr.1000110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chiropractic cervical manipulation is a common practice utilized around the world. Most patients are never cleared medically for manipulation, which can be devastating for those few who are at increased risk for dissections. The high velocity thrust used in cervical manipulation can produce significant strain on carotid and vertebral vessels. Once a dissection has occurred, the risk of thrombus formation, ischemic stroke, paralysis, and even death is drastically increased. In this case report, we highlight a case of a 32-year-old woman who underwent chiropractic manipulation and had vertebral artery dissection with subsequent brainstem infarct. She quickly deteriorated and passed away shortly after arrival to the hospital. Although rare, one in 48 chiropractors have experienced such an event. We utilize this case to highlight the risk associated with cervical manipulation and urge open dialogue between chiropractors and physicians. Receiving medical clearance prior to cervical manipulation in potential at risk patients would drastically reduce morbidity and mortality.
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Affiliation(s)
- Ryan C Turner
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, West Virginia
- West Virginia Clinical & Translational Science Institute, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Brandon P Lucke-Wold
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, West Virginia
- West Virginia Clinical & Translational Science Institute, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Sohyun Boo
- Department of Radiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Charles L Rosen
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia
- Center for Neuroscience, West Virginia University School of Medicine, Morgantown, West Virginia
- West Virginia Clinical & Translational Science Institute, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Cara L Sedney
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia
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Millet JD, Cavallo JJ, Scoutt LM, Gunabushanam G. Sonographic Evaluation of Complications of Extracranial Carotid Artery Interventions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:769-781. [PMID: 28877355 DOI: 10.1002/jum.14376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 06/07/2023]
Abstract
Carotid endarterectomy and carotid artery stenting are among the most common peripheral vascular procedures performed worldwide. Sonography is the initial and often only imaging modality used in the evaluation of iatrogenic carotid arterial injuries. This pictorial essay provides an overview of the clinical and sonographic findings of complications after interventions in the extracranial carotid arteries, including dissection, fluid collections, pseudoaneurysm, thrombosis, thromboembolism, restenosis, and stent deformation. Grayscale, color, and pulsed Doppler imaging findings are reviewed, and correlations with computed tomography, magnetic resonance imaging, and angiography are provided.
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Affiliation(s)
- John D Millet
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Joseph J Cavallo
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Leslie M Scoutt
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gowthaman Gunabushanam
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
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46
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University education and cervical artery dissection. J Neurol 2018; 265:1065-1070. [DOI: 10.1007/s00415-018-8798-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 10/18/2022]
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Narula N, Siddiqui F, Katyal N, Avula A, Chalhoub M. Internal Carotid Artery Dissection with Lidocaine Nerve Block Injection Trauma: A Rare Case Report. Cureus 2018. [PMID: 29531880 PMCID: PMC5837233 DOI: 10.7759/cureus.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Internal carotid artery dissection (ICAD) accounts for 25% of cerebrovascular accidents in young and middle-aged patients. Dissection occurs when the intimal wall of an artery is damaged as a result of trauma or defect. ICAD development after dental work is a relatively uncommon phenomenon. Our study highlights a rare presentation of ICAD that resulted from a direct lidocaine nerve block injection in a patient undergoing pulpotomy for a right maxillary second premolar tooth. We have described the case and reviewed the literature on this rare but potentially life-threatening phenomenon.
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Affiliation(s)
| | - Faraz Siddiqui
- Pulmonary and Critical Care, Staten Island University Hospital
| | | | - Akshay Avula
- Pulmonary and Critical Care, Staten Island University Hospital
| | - Michel Chalhoub
- Pulmonary and Critical Care, Staten Island University Hospital
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Spontaneous cervical artery dissection is accompanied by a hypercoagulable state and simultaneous inflammatory condition. J Neurol 2017; 265:308-314. [DOI: 10.1007/s00415-017-8696-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 12/26/2022]
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Abstract
OPINION STATEMENT Optimal diagnosis and management of stroke in young adults benefit from a multidisciplinary team, including a vascular neurology specialist. In addition to the "standard" vascular risk factors including smoking, hypertension, diabetes, and hyperlipidemia, one needs to consider alternative etiologies including substance abuse, carotid/vertebral artery dissections, and rare genetic conditions among others. Once a young patient is determined to have had a stroke, the next question a clinician should ask is why did this patient have a stroke? A "heart to head" diagnostic approach is recommended. A thorough history is performed, including a detailed family history with specific annotations on each family member. A thorough physical examination is necessary including a careful evaluation of the patient's general appearance, noting any joint laxity, and/or abnormalities of the skin, eyes, and heart. Findings across multiple organ systems in the patient and/or their family may indicate a genetic etiology. After an initial head CT rules out hemorrhagic stroke, additional testing should include a brain MRI, neck and cerebral vascular imaging (e.g., CTA for head and neck), transthoracic echocardiogram with a bubble study, telemetry monitoring, basic risk factor blood work (e.g., lipid panel, hemoglobin A1c, TSH, ESR, CRP, RPR, HIV, and toxicology screen), and, when appropriate, sickle screen and pregnancy test. There should be a low threshold to obtain blood cultures or a lumbar puncture. The acute treatment of ischemic stroke in young adult patients does not differ from treatment of older adults, using intravenous alteplase within 4.5 h, assuming no contraindications. In suspected proximal large artery occlusive disease, interventional clot extraction procedures should be employed in patients deemed eligible. Long-term secondary prevention strategies aimed to reduce recurrent stroke risk by targeting and modifying vascular risk factors should be instituted. The mainstay of preventative therapy is aspirin for most etiologies; however, for atrial fibrillation, anticoagulation is recommended. Statin therapy is another pharmacologic intervention recommended in most stroke patients. Other measures employed are blood pressure reduction, smoking cessation, optimal glucose control in diabetic patients, the initiation of a healthy diet and regular exercise, and lastly, substance abuse counseling in appropriate patients.
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Affiliation(s)
- Christopher A Stack
- Department of Neurology, University of Maryland Medical Center, 16 South Eutaw Street Suite 300, Baltimore, MD, 21201, USA
| | - John W Cole
- Department of Neurology, Baltimore VA Medical Center, University of Maryland School of Medicine, 12th Floor, Bressler Building, Room 12-006, 655 West Baltimore Street, Baltimore, MD, 21201-1559, USA.
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CHEN YAN, FANG YIBIN, YANG PENGFEI, HUANG QINGHAI, LIU JIANMIN. WHICH MORPHOLOGIC AND HEMODYNAMIC CHARACTERISTICS PREDICT INTRACRANIAL FUSIFORM ANEURYSMS RUPTURE? A PATIENT-SPECIFIC COMPUTATIONAL FLUID DYNAMICS STUDY. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To identify hemodynamic and morphological parameters leading to increased risk of intracranial fusiform aneurysms (IFA) rupture using computational fluid dynamics (CFDs). A total of 24 patient-specific fusiform aneurysms models on vertebral artery were reconstructed from 3D angiography images. 11 ruptured cases and 13 unruptured cases were included. Morphologic parameters were measured and CFD parameters were calculated using CFD simulation. The length of the aneurysm is significantly shorter in ruptured group than in unruptured group. The ratio of the width to the length of an aneurysm (WLR) and the ratio of the cross-section area to the length of an aneurysm (ALR) to the averaged cross sectional areas of the inlet and outlet of the parent artery (ALaR) were significantly higher in ruptured group compared with unruptured group. Wall shear stress (WSS) of the aneurysm was normalized to the WSS of the parent artery. Hemodynamically, only low WSS was associated with higher risk of rupture. Ruptured IFAs are shorter, have bigger WLR, ALaR, and lower WSS, compared with unruptured IFAs.
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Affiliation(s)
- YAN CHEN
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
| | - YI-BIN FANG
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
| | - PENG-FEI YANG
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
| | - QING-HAI HUANG
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
| | - JIAN-MIN LIU
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, P. R. China
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