HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Mokri, B. Articles by Piepgras, D. G. Search for Related Content PubMed PubMed Citation Articles by Mokri, B. Articles by Piepgras, D. G.

Spontaneous dissections of the vertebral arteries

From the Departments of Neurology (Drs. Mokri and Sandok), Diagnostic Radiology (Dr. Houser), and Neurologic Surgery (Dr. Piepgras), Mayo Clinic and Mayo Foundation, Rochester, MN.

Clinical and angiographic features and outcome in 25 patients with spontaneous dissections of the vertebral arteries are described. Most patients were in their fourth or fifth decade of life, and women predominated. Forty-eight percent of the patients were hypertensive. Angiographic evidence of fibromuscular dysplasia was noted in one only. Brainstem ischemic symptoms (usually a lateral medullary syndrome) and ipsilateral occipital headache and neck pain (often preceding but sometimes associated with or following the brainstem ischemic event) were the most common clinical findings. The angiographic features in decreasing order of frequency were luminal stenosis (often irregular and tapered), aneurysm, occlusion, and intimal flap. On follow-up, most of the patients (88%) made complete or very good recoveries. Angiographic abnormalities either subsided or improved in 76%. Multivessel dissection (involvement of both vertebral arteries or one or both vertebral arteries and one or both internal carotid arteries) was noted in about two-thirds of the patients. This tendency of vertebral artery dissections to involve multiple cervicocephalic vessels concurrently, if not simultaneously, implies that four-vessel angiography should be attempted if a vertebral artery dissection is visualized. It also raises the possibility of an underlying arteriopathy that predisposes the vessel to dissection.

Address correspondence and reprint requests to Dr. Mokri, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Received August 17, 1987. Accepted for publication in final form December 15, 1987.

This article has been cited by other articles:

				S.-C. Jin, D.H. Kwon, C.-G. Choi, J.S. Ahn, and B.-D. Kwun Endovascular Strategies for Vertebrobasilar Dissecting Aneurysms AJNR Am. J. Neuroradiol., September 1, 2009; 30(8): 1518 - 1523. [Abstract] [Full Text] [PDF]

				C. Lum, S. Chakraborty, M. Schlossmacher, M. Santos, R. Mohan, J. Sinclair, and M. Sharma Vertebral Artery Dissection with a Normal-Appearing Lumen at Multisection CT Angiography: The Importance of Identifying Wall Hematoma AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 787 - 792. [Abstract] [Full Text] [PDF]

				U. Umasankar, T. J. Carroll, A. Famuboni, M. D. Patel, and I. D. Starke Vertebral artery dissection: not a rare cause of stroke in the young Age Ageing, May 1, 2008; 37(3): 345 - 346. [Abstract] [Full Text] [PDF]

				J. S. Lee, S. W. Yong, O. Y. Bang, Y. S. Shin, B. M. Kim, and S. Y. Kim Comparison of Spontaneous Intracranial Vertebral Artery Dissection With Large Artery Disease Arch Neurol, December 1, 2006; 63(12): 1738 - 1744. [Abstract] [Full Text] [PDF]

				V. H. Lee, R. D. Brown Jr, J. N. Mandrekar, and B. Mokri Incidence and outcome of cervical artery dissection: A population-based study Neurology, November 28, 2006; 67(10): 1809 - 1812. [Abstract] [Full Text] [PDF]

				M. Arnold, M. G. Bousser, G. Fahrni, U. Fischer, D. Georgiadis, J. Gandjour, D. Benninger, M. Sturzenegger, H. P. Mattle, and R. W. Baumgartner Vertebral Artery Dissection: Presenting Findings and Predictors of Outcome Stroke, October 1, 2006; 37(10): 2499 - 2503. [Abstract] [Full Text] [PDF]

				A. Biondi, B. Jean, E. Vivas, L. Le Jean, A.L. Boch, J. Chiras, and R. Van Effenterre Giant and large peripheral cerebral aneurysms: etiopathologic considerations, endovascular treatment, and long-term follow-up. AJNR Am. J. Neuroradiol., September 1, 2006; 27(8): 1685 - 1692. [Abstract] [Full Text] [PDF]

				M. Mazighi, J.-P. Saint Maurice, A. Rogopoulos, and E. Houdart Extracranial vertebral and carotid dissection occurring in the course of subarachnoid hemorrhage Neurology, November 8, 2005; 65(9): 1471 - 1473. [Abstract] [Full Text] [PDF]

				S. I. Savitz and L. R. Caplan Vertebrobasilar Disease N. Engl. J. Med., June 23, 2005; 352(25): 2618 - 2626. [Full Text] [PDF]

				J. E. de Sousa, M. J. Halfon, P. Bonardo, R. C. Reisin, and M. M. Fernandez Pardal Different pain patterns in patients with vertebral artery dissections Neurology, March 8, 2005; 64(5): 925 - 926. [Full Text] [PDF]

				C.-J. Chen, Y.-C. Tseng, T.-H. Lee, H.-L. Hsu, and L.-C. See Multisection CT Angiography Compared with Catheter Angiography in Diagnosing Vertebral Artery Dissection AJNR Am. J. Neuroradiol., May 1, 2004; 25(5): 769 - 774. [Abstract] [Full Text] [PDF]

				E. Touze, C. Oppenheim, M. Zuber, E. Meary, J.F. Meder, and J.L. Mas Early asymptomatic recurrence of cervical artery dissection: Three cases Neurology, August 26, 2003; 61(4): 572 - 574. [Abstract] [Full Text] [PDF]

				W. S. Smith, S. C. Johnston, E. J. Skalabrin, M. Weaver, P. Azari, G. W. Albers, and D. R. Gress Spinal manipulative therapy is an independent risk factor for vertebral artery dissection Neurology, May 13, 2003; 60(9): 1424 - 1428. [Abstract] [Full Text] [PDF]

				H. Ohkuma, S. Suzuki, T. Kikkawa, and N. Shimamura Neuroradiologic and Clinical Features of Arterial Dissection of the Anterior Cerebral Artery AJNR Am. J. Neuroradiol., April 1, 2003; 24(4): 691 - 699. [Abstract] [Full Text] [PDF]

				H. Ohkuma, S. Suzuki, and K. Ogane Dissecting Aneurysms of Intracranial Carotid Circulation Stroke, April 1, 2002; 33(4): 941 - 947. [Abstract] [Full Text] [PDF]

				H. J. Fullerton, S. C. Johnston, and W. S. Smith Arterial dissection and stroke in children Neurology, October 9, 2001; 57(7): 1155 - 1160. [Abstract] [Full Text] [PDF]

				E. Touze, B. Randoux, E. Meary, C. Arquizan, J.-F. Meder, and J.-L. Mas Aneurysmal Forms of Cervical Artery Dissection : Associated Factors and Outcome Stroke, February 1, 2001; 32(2): 418 - 423. [Abstract] [Full Text] [PDF]

				J. H. Shin, D. C. Suh, C. G. Choi, and H. K. Lee Vertebral Artery Dissection: Spectrum of Imaging Findings with Emphasis on Angiography and Correlation with Clinical Presentation RadioGraphics, November 1, 2000; 20(6): 1687 - 1696. [Abstract] [Full Text] [PDF]

				X. Leclerc, C. Lucas, O. Godefroy, L. Nicol, A. Moretti, D. Leys, and J. P. Pruvo Preliminary Experience Using Contrast-Enhanced MR Angiography to Assess Vertebral Artery Structure for the Follow-up of Suspected Dissection AJNR Am. J. Neuroradiol., September 1, 1999; 20(8): 1482 - 1490. [Abstract] [Full Text]

				T. Hosoya, M. Adachi, K. Yamaguchi, T. Haku, T. Kayama, and T. Kato Clinical and Neuroradiological Features of Intracranial Vertebrobasilar Artery Dissection Stroke, May 1, 1999; 30(5): 1083 - 1090. [Abstract] [Full Text] [PDF]

				F. G. Greiner and D. Takhtani Neuroradiology Case of the Day RadioGraphics, January 1, 1999; 19(1): 255 - 258. [Full Text] [PDF]

				T. Hundsberger, F. Thomke, H. C. Hopf, and C. Fitzek Symmetrical Infarction of the Cervical Spinal Cord Due to Spontaneous Bilateral Vertebral Artery Dissection Stroke, August 1, 1998; 29(8): 1742 - 1742. [Full Text]

				A Auer, S Felber, C Schmidauer, P Waldenberger, and F Aichner Magnetic resonance angiographic and clinical features of extracranial vertebral artery dissection J. Neurol. Neurosurg. Psychiatry, April 1, 1998; 64(4): 474 - 481. [Abstract] [Full Text] [PDF]

				J. S. Kim, J. H. Lee, and C. G. Choi Patterns of Lateral Medullary Infarction : Vascular Lesion–Magnetic Resonance Imaging Correlation of 34 Cases Stroke, March 1, 1998; 29(3): 645 - 652. [Abstract] [Full Text] [PDF]

				J M de Bray, I Penisson-Besnier, F Dubas, and J Emile Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis J. Neurol. Neurosurg. Psychiatry, July 1, 1997; 63(1): 46 - 51. [Abstract] [Full Text] [PDF]

				A. Culebras, C. S. Kase, J. C. Masdeu, A. J. Fox, R. N. Bryan, C. B. Grossman, D. H. Lee, H. P. Adams, W. Thies, and E. O. Members Practice Guidelines for the Use of Imaging in Transient Ischemic Attacks and Acute Stroke : A Report of the Stroke Council, American Heart Association Stroke, July 1, 1997; 28(7): 1480 - 1497. [Full Text]

				Y. Yoshimoto and S. Wakai Unruptured Intracranial Vertebral Artery Dissection: Clinical Course and Serial Radiographic Imagings Stroke, February 1, 1997; 28(2): 370 - 374. [Abstract] [Full Text]

				L. B. Goldstein, L. Gray, and C. M. Hulette Stroke Due to Recurrent Ipsilateral Carotid Artery Dissection in a Young Adult Stroke, March 1, 1995; 26(3): 480 - 483. [Abstract] [Full Text]

				L.R. Caplan and E.T. Hedley-Whyte Case 5-1995- A 73-year-old man with focal brain lesions and peripheral-nerve disease N. Engl. J. Med., February 16, 1995; 332(7): 452 - 459. [Full Text] [PDF]

				W. I. Schievink, B. Mokri, and W. M. O'Fallon Recurrent Spontaneous Cervical-Artery Dissection N. Engl. J. Med., February 10, 1994; 330(6): 393 - 397. [Abstract] [Full Text]

				R. L. Sacco, L. Freddo, J. A. Bello, J. G. Odel, S. T. Onesti, and J. P. Mohr Wallenberg's Lateral Medullary Syndrome: Clinical-Magnetic Resonance Imaging Correlations Arch Neurol, June 1, 1993; 50(6): 609 - 614. [Abstract] [PDF]

				A. Reisner and D. L. Barrow Intracranial and Extracranial Aspects of Carotid Fibromuscular Dysplasia Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1992; 5(2): 31 - 57. [PDF]