Spontaneous Dissections of Cervicocephalic Arteries

A dissection is a hematoma within the arterial wall, that can be spontaneous or the result of trauma. Cervicocephalic arterial dissections are a common cause of cerebrovascular disease, particularly in younger patients in whom atherosclerosis is less prevalent. The clinical presentation of dissections is variable. The pain fibers within the arterial wall are compressed by dissection causing ipsilateral headaches or neck pain, sometimes as the only symptom. Dissections of the cervicocephalic arteries can also result in an ischemic stroke or a subarachnoid hemorrhage. The arterial hematoma can result in a flow-limited lesion or an intramural thrombus, either of which can lead to brain ischemia. Dissection in intracranial vessels can also result in a “pseudoaneurysm” (dissecting aneurysm) that can cause a subarachnoid hemorrhage if it ruptures. Prevention of further ischemic events is typically done with antithrombotic agents, and endovascular procedures in complicated cases. Brain ischemia secondary to cervicocephalic arterial dissections has generally a better prognosis than ischemia due to atherosclerotic cerebrovascular disease.