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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 64, Number 9, May 10, 2005 Data Supplement All Versions of this Article: 01.WNL.0000159739.24607.98v1 64/9/1508    most recent 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 Völker, W. Articles by Kuhlenbäumer, G. Search for Related Content PubMed PubMed Citation Articles by Völker, W. Articles by Kuhlenbäumer, G. Related Collections All Cerebrovascular disease/Stroke Carotid artery dissection

Generalized arteriopathy in patients with cervical artery dissection

From the Institute of Atherosclerosis Research (Drs. Völker, Ringelstein, and Kuhlenbäumer), Münster, Germany; and the Departments of Neurology (Drs. Besselmann, Dittrich, Nabavi, Konrad, Dziewas, Evers, Stögbauer, Ringelstein, and Kuhlenbäumer), Psychiatry (Drs. Konrad and Grewe), Ophthalmology (Drs. Krämer and Bachmann), University of Münster, Münster, Germany.

Address correspondence and reprint requests to Dr. G. Kuhlenbäumer, Institute of Atherosclerosis Research, University of Münster, Domagkstr. 3, D-48149 Münster, Germany; e-mail: gkuhlen{at}uni-muenster.de

Objective: To make an ultrastructural comparison of superficial temporal artery (STA) biopsy specimens from patients with spontaneous cervical artery dissection (sCAD) and controls.

Methods: The authors used light microscopic examination of semithin sections and electron microscopic examination of ultrathin sections of STA biopsy specimens from patients with sCAD and controls.

Results: STA biopsy specimens from patients with sCAD taken around the time of the dissection showed a zone of connective tissue weakening with fissuring at the junction between the tunica media (TM) and the tunica adventitia (TA) in seven of nine specimens and erythrocyte infiltration in eight of nine specimens but in none of the control specimens. Light microscopy demonstrated transparent circular spots that, on electron microscopy, turned out to represent erythrocytes and other cellular components at different stages of degradation. Occasionally, scattered immune cells were found in specimens from patients with sCAD. In addition, smooth muscle cells of the synthetic phenotype, some of them showing extensive vacuolation were more common in the TM of STA biopsy specimens from patients with sCAD than in control specimens.

Conclusions: Signs of tissue weakening along the TM/TA junction in STA biopsy specimens of patients with sCAD but not in controls suggest the presence of a generalized arteriopathy leading to impairment of the stability of the arterial wall in patients with sCAD. Limiting factors of the study are that some control biopsies were obtained from autopsies and that the anticoagulation status of patients and controls were not completely comparable.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the May 10 issue to find the link for this article.

See Commentary, page 1491

*These authors contributed equally to this work.

Supported by a grant from the Deutsche Schlaganfallhilfe and the Bundesministerium für Bildung und Forschung (Kompetenznetz Schlaganfall, 01GI 2909/3).

Received May 10, 2004. Accepted in final form January 26, 2005.

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