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From the Departments of Neurology (Drs. R.W. Baumgartner, Mosso, and Studer) and Neuroradiology (Dr. Schuknecht), University Hospital Zurich; and Departments of Neurology (Drs. Arnold, Gönner, and Sturzenegger) and Neuroradiology (Dr. Schroth) and Swiss Cardiovascular Center, Division of Angiology (Dr. I. Baumgartner), University Hospital Bern, Switzerland.
Address correspondence to Prof. Dr. R.W. Baumgartner, Department of Neurology, University Hospital, Frauenklinikstrasse 26, CH-8091 Zurich, Switzerland; e-mail: ralf.baumgartner{at}nos.usz.ch
Objective: — To study whether spontaneous dissections of the cervical internal carotid artery dissection (ICAD) with and without ischemia of the brain or retina differ in the prevalence of vascular risk factors, local neurologic signs and symptoms, and stenoses and occlusions of the cerebral arteries.
Methods: — The authors prospectively studied 181 consecutive patients with 200 ICAD. Diagnosis was based on ultrasonography and MRI or catheter angiography. Vascular risk factors, presenting local (headache, neck pain, Horner syndrome, pulsatile tinnitus, cranial nerve palsy on the side of the ICAD) and ischemic signs and symptoms, and ultrasonographic findings in the carotid and basal cerebral arteries were evaluated.
Results: — ICAD with ischemic events (n = 145) had a higher prevalence of hypercholesterolemia (p < 0.05), >80% stenoses and occlusions of the ICA (p < 0.0001), and intracranial obstructions (p < 0.001). ICAD without ischemic events (n = 55) had a higher prevalence of Horner syndrome (p < 0.001), cranial nerve palsy (p < 0.01), and normal ICA findings (p < 0.0001).
Conclusions: — These data suggest that ICAD causing high-grade stenosis and occlusion are more likely to lead to intracranial obstructions and cerebral or retinal ischemic events. Conversely, ICAD without luminal narrowing cause more local signs and symptoms.
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