FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 344:898-906 March 22, 2001 Number 12 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF Purchase this article Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

When a tear occurs in one of the major arteries in the neck and allows blood to enter the wall of the artery and split its layers, the result is either stenosis or aneurysmal dilatation of the vessel. This process was long thought to be a rare cause of stroke, particularly in the absence of trauma, and the diagnosis was usually not made until the postmortem examination.^1,2,3 It was not until the late 1970s, when Fisher et al.¹ and Mokri et al.² described dissections of carotid and vertebral arteries as detected by modern diagnostic approaches, that dissections began to be . . . [Full Text of this Article]

Epidemiologic Features

Pathological Features

Pathogenesis

Genetic Factors

Environmental Factors

Clinical Manifestations

Dissection of the Internal Carotid Artery

            Local Manifestations

            Ischemic Manifestations

Vertebral-Artery Dissection

            Local Manifestations

            Ischemic Manifestations

Diagnostic Tests

Prognosis

Treatment

Source Information

From the Cedars–Sinai Neurosurgical Institute, Los Angeles, and the Department of Neurosurgery, University of California, Irvine.

Address reprint requests to Dr. Schievink at the Maxine Dunitz Neurosurgical Institute, Cedars–Sinai Medical Center, 8631 W. Third St., 800E, Los Angeles, CA 90048, or at schievinkw@cshs.org.

References

This article has been cited by other articles:

• Provenzale, J. M., Sarikaya, B. (2009). Comparison of Test Performance Characteristics of MRI, MR Angiography, and CT Angiography in the Diagnosis of Carotid and Vertebral Artery Dissection: A Review of the Medical Literature. Am. J. Roentgenol. 193: 1167-1174 [Abstract] [Full Text]  
• Oppenheim, C., Naggara, O., Touze, E., Lacour, J.-C., Schmitt, E., Bonneville, F., Crozier, S., Guegan-Massardier, E., Gerardin, E., Leclerc, X., Neau, J.-P., Sirol, M., Toussaint, J.-F., Mas, J.-L., Meder, J.-F. (2009). High-Resolution MR Imaging of the Cervical Arterial Wall: What the Radiologist Needs to Know. RadioGraphics 29: 1413-1431 [Abstract] [Full Text]  
• Songu, M., Cingi, C. (2009). Sneeze reflex: facts and fiction. Ther Adv Respir Dis 3: 131-141 [Abstract]  
• Debette, S., Markus, H. S. (2009). The Genetics of Cervical Artery Dissection: A Systematic Review. Stroke 40: e459-e466 [Abstract] [Full Text]  
• Cianci, R., Gigante, A., Barbano, B., Zaccaria, A., Polidori, L., Borghesi, F., Gasperini, L., Di Donato, D., Amoroso, A. (2009). Multiple steno-obstructive vascular lesions and femoral superficial artery dissection in a young Caucasian male with antiphospholipid syndrome. BMJ Case Reports 2009: bcr1220081342-bcr1220081342 [Abstract] [Full Text]  
• Rane, N., Mcauley, D. (2009). Vertebral artery dissection presenting as isolated vertigo. BMJ Case Reports 2009: bcr1120081238-bcr1120081238 [Abstract] [Full Text]  
• Garry, D, Forrest-Hay, A (2009). A headache not to be sneezed at. Emerg. Med. J. 26: 384-385 [Abstract] [Full Text]  
• Tan, M. A., Armstrong, D., MacGregor, D. L., Kirton, A. (2009). Late Complications of Vertebral Artery Dissection in Children: Pseudoaneurysm, Thrombosis, and Recurrent Stroke. J Child Neurol 24: 354-360 [Abstract]  
• Vertinsky, A.T., Schwartz, N.E., Fischbein, N.J., Rosenberg, J., Albers, G.W., Zaharchuk, G. (2008). Comparison of Multidetector CT Angiography and MR Imaging of Cervical Artery Dissection. Am. J. Neuroradiol. 29: 1753-1760 [Abstract] [Full Text]  
• Rodallec, M. H., Marteau, V., Gerber, S., Desmottes, L., Zins, M. (2008). Craniocervical Arterial Dissection: Spectrum of Imaging Findings and Differential Diagnosis1. RadioGraphics 28: 1711-1728 [Abstract] [Full Text]  
• Ribbons, T, Bell, S (2008). Neck pain and minor trauma: normal radiographs do not always exclude serious pathology. Emerg. Med. J. 25: 609-610 [Abstract] [Full Text]  
• Volker, W, Ringelstein, E B, Dittrich, R, Maintz, D, Nassenstein, I, Heindel, W, Grewe, S, Kuhlenbaumer, G (2008). Morphometric analysis of collagen fibrils in skin of patients with spontaneous cervical artery dissection. J. Neurol. Neurosurg. Psychiatry 79: 1007-1012 [Abstract] [Full Text]  
• Roach, E. S., Golomb, M. R., Adams, R., Biller, J., Daniels, S., deVeber, G., Ferriero, D., Jones, B. V., Kirkham, F. J., Scott, R. M., Smith, E. R. (2008). Management of Stroke in Infants and Children: A Scientific Statement From a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke 39: 2644-2691 [Abstract] [Full Text]  
• Menon, R K, Markus, H S, Norris, J W (2008). Results of a UK questionnaire of diagnosis and treatment in cervical artery dissection. J. Neurol. Neurosurg. Psychiatry 79: 612-612 [Full Text]  
• Baracchini, C., Tonello, S., Vitaliani, R., Giometto, B., Meneghetti, G., Ballotta, E. (2008). Vasomotion in Multiple Spontaneous Cervical Artery Dissections. Stroke 39: 1148-1151 [Abstract] [Full Text]  
• Ui, J., Sivaswamy, L. (2008). Hemiplegia in an 11-Year-Old. CLIN PEDIATR 47: 199-202  
• KAMINSKI, M. A., TAN, C. D., ASKARI, A. T. (2008). A young man with acute weakness of his right arm. Cleveland Clinic Journal of Medicine 75: 145-152 [Full Text]  
• Rane, N J, Mcauley, D (2007). Vertebral artery dissection presenting as isolated vertigo. Emerg. Med. J. 24: 732-732 [Abstract] [Full Text]  
• Engelter, S. T., Brandt, T., Debette, S., Caso, V., Lichy, C., Pezzini, A., Abboud, S., Bersano, A., Dittrich, R., Grond-Ginsbach, C., Hausser, I., Kloss, M., Grau, A. J., Tatlisumak, T., Leys, D., Lyrer, P. A., for the Cervical Artery Dissection in Ischemic Str, (2007). Antiplatelets Versus Anticoagulation in Cervical Artery Dissection. Stroke 38: 2605-2611 [Abstract] [Full Text]  
• Dittrich, R., Nassenstein, I., Bachmann, R., Maintz, D., Nabavi, D. G., Heindel, W., Kuhlenbaumer, G., Ringelstein, E. B. (2007). Polyarterial clustered recurrence of cervical artery dissection seems to be the rule. Neurology 69: 180-186 [Abstract] [Full Text]  
• Dittrich, R., Heidbreder, A., Rohsbach, D., Schmalhorst, J., Nassenstein, I., Maintz, D., Ringelstein, E. B., Nabavi, D. G., Kuhlenbaumer, G. (2007). Connective tissue and vascular phenotype in patients with cervical artery dissection. Neurology 68: 2120-2124 [Abstract] [Full Text]  
• D'Ambrosio, N., Friedman, B., Siegel, D., Katz, D., Newatia, A., Hines, J. (2007). Spontaneous Isolated Dissection of the Celiac Artery: CT Findings in Adults. Am. J. Roentgenol. 188: W506-W511 [Abstract] [Full Text]  
• Bates, E. R., Babb, C. J. D., Casey, D. E., Cates, C. U., Duckwiler, G. R., Feldman, T. E., Gray, W. A., Ouriel, K., Peterson, E. D., Rosenfield, K., Rundback, J. H., Safian, R. D., Sloan, M. A., White, C. J. (2007). ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting). Vasc Med 12: 35-83  
• American Society of Interventional & Therapeutic N, , Society for Cardiovascular Angiography and Interve, , Society for Vascular Medicine and Biology, , Society of Interventional Radiology, , Bates, E. R., Babb, J. D., Casey, D. E. Jr, Cates, C. U., Duckwiler, G. R., Feldman, T. E., Gray, W. A., Ouriel, K., Peterson, E. D., Rosenfield, K., Rundback, J. H., Safian, R. D., Sloan, M. A., White, C. J., Harrington, R. A., Abrams, J., Anderson, J. L., Bates, E. R., Eisenberg, M. J., Grines, C. L., Hlatky, M. A., Lichtenberg, R. C., Lindner, J. R., Pohost, G. M., Schofield, R. S., Shubrooks, S. J. JR, Stein, J. H., Tracy, C. M., Vogel, R. A., Wesley, D. J. (2007). ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting). J Am Coll Cardiol 49: 126-170 [Full Text]  
• Lee, J. S., Yong, S. W., Bang, O. Y., Shin, Y. S., Kim, B. M., Kim, S. Y. (2006). Comparison of Spontaneous Intracranial Vertebral Artery Dissection With Large Artery Disease. Arch Neurol 63: 1738-1744 [Abstract] [Full Text]  
• Martin, J. J., Hausser, I., Lyrer, P., Busse, O., Schwarz, R., Schneider, R., Brandt, T., Kloss, M., Schwaninger, M., Engelter, S., Grond-Ginsbach, C. (2006). Familial Cervical Artery Dissections: Clinical, Morphologic, and Genetic Studies. Stroke 37: 2924-2929 [Abstract] [Full Text]  
• Ahn, J.Y., Han, I.B., Kim, T.G., Yoon, P.H., Lee, Y.J., Lee, B.-H., Seo, S.H., Kim, D.I., Hong, C.K., Joo, J.Y. (2006). Endovascular Treatment of Intracranial Vertebral Artery Dissections with Stent Placement or Stent-assisted Coiling. Am. J. Neuroradiol. 27: 1514-1520 [Abstract] [Full Text]  
• Wiest, T., Hyrenbach, S., Bambul, P., Erker, B., Pezzini, A., Hausser, I., Arnold, M.-L., Martin, J. J., Engelter, S., Lyrer, P., Busse, O., Brandt, T., Grond-Ginsbach, C. (2006). Genetic Analysis of Familial Connective Tissue Alterations Associated With Cervical Artery Dissections Suggests Locus Heterogeneity. Stroke 37: 1697-1702 [Abstract] [Full Text]  
• Lanczik, O., Szabo, K., Lecei, O., Binder, J., Thiel, S., Gass, A., Hennerici, M. (2006). Central respiratory dysfunction following vertebral artery dissection. Neurology 66: 944-944 [Full Text]  
• Pezzini, A, Caso, V, Zanferrari, C, Del Zotto, E, Paciaroni, M, Bertolino, C, Grassi, M, Agnelli, G, Padovani, A (2006). Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case-control study. J. Neurol. Neurosurg. Psychiatry 77: 95-97 [Abstract] [Full Text]  
• Rafay, M. F., Armstrong, D., deVeber, G., Domi, T., Chan, A., MacGregor, D. L. (2006). Craniocervical Arterial Dissection in Children: Clinical and Radiographic Presentation and Outcome. J Child Neurol 21: 8-16 [Abstract]  
• Mellion, M. L., Rizvi, S. (2005). Spontaneous bilateral carotid artery dissection and posterior reversible encephalopathy syndrome. Neurology 65: 1990-1990 [Full Text]  
• Garewal, M., Selhorst, J. B. (2005). Subclavian Artery Dissection and Triple Infarction of the Nervous System. Arch Neurol 62: 1917-1919 [Abstract] [Full Text]  
• Mazighi, M., Saint Maurice, J.-P., Rogopoulos, A., Houdart, E. (2005). Extracranial vertebral and carotid dissection occurring in the course of subarachnoid hemorrhage. Neurology 65: 1471-1473 [Abstract] [Full Text]  
• ROZ, T. M., SCHIFFMAN, L. E., SCHLOSSBERG, S. (2005). Spontaneous dissection of the internal carotid artery manifesting as pain in an endodontically treated molar. Journal of the American Dental Association 136: 1556-1559 [Abstract] [Full Text]  
• Kadkhodayan, Y., Jeck, D. T., Moran, C. J., Derdeyn, C. P., Cross, D. T. III (2005). Angioplasty and Stenting in Carotid Dissection with or without Associated Pseudoaneurysm. Am. J. Neuroradiol. 26: 2328-2335 [Abstract] [Full Text]  
• Biondi, A., Katz, J. M., Vallabh, J., Segal, A. Z., Gobin, Y. P. (2005). Progressive Symptomatic Carotid Dissection Treated With Multiple Stents. Stroke 36: e80-e82 [Abstract] [Full Text]  
• Lyrer, P.A. (2005). Extracranial Arterial Dissection: Anticoagulation Is the Treatment of Choice: Against. Stroke 36: 2042-2043 [Full Text]  
• Joseph, T, Kandiyil, N, Beale, D, Tiivas, C, Imray, C H E (2005). A novel treatment for symptomatic carotid dissection. Postgrad. Med. J. 81: e6-e6 [Full Text]  
• Nohe, B., Ernemann, U., Tepe, G., Ritz, R., Bail, D. (2005). Aortic Dissection Mimicking Subarachnoidal Hemorrhage. Anesth. Analg. 101: 233-234 [Abstract] [Full Text]  
• Rubinstein, S. M., Peerdeman, S. M., van Tulder, M. W., Riphagen, I., Haldeman, S. (2005). A Systematic Review of the Risk Factors for Cervical Artery Dissection. Stroke 36: 1575-1580 [Abstract] [Full Text]  
• Savitz, S. I., Caplan, L. R. (2005). Vertebrobasilar Disease. NEJM 352: 2618-2626 [Full Text]  
• Pego-Reigosa, R., Lopez-Lopez, S., Vazquez-Lopez, M. E., Armesto-Perez, V., Branas-Fernandez, F., Martinez-Vazquez, F., Pineiro-Bolano, R., Cortes-Laino, J. A. (2005). Sea wave-induced internal carotid artery dissection. Neurology 64: 1980-1980 [Full Text]  
• Thanvi, B, Munshi, S K, Dawson, S L, Robinson, T G (2005). Carotid and vertebral artery dissection syndromes. Postgrad. Med. J. 81: 383-388 [Abstract] [Full Text]  
• de Sousa, J. E., Halfon, M. J., Bonardo, P., Reisin, R. C., Fernandez Pardal, M. M. (2005). Different pain patterns in patients with vertebral artery dissections. Neurology 64: 925-926 [Full Text]  
• Abboud, H, Houdart, E, Meseguer, E, Amarenco, P (2005). Stent assisted endovascular thrombolysis of internal carotid artery dissection. J. Neurol. Neurosurg. Psychiatry 76: 292-293 [Full Text]  
• Campos, C. R., Basso, M., Evaristo, E. F., Yamamoto, F. I., Scaff, M. (2004). Bilateral carotid artery dissection with thyrotoxicosis. Neurology 63: 2443-2444 [Full Text]  
• Laufs, H., Weidauer, S., Heller, C., Lorenz, M., Neumann-Haefelin, T. (2004). Hemi-spinal cord infarction due to vertebral artery dissection in congenital afibrinogenemia. Neurology 63: 1522-1523 [Abstract] [Full Text]  
• Censori, B., Agostinis, C., Partziguian, T., Guagliumi, G., Bonaldi, G., Poloni, M. (2004). Spontaneous dissection of carotid and coronary arteries. Neurology 63: 1122-1123 [Abstract] [Full Text]  
• Adkins, A. L., Zelenock, G. B., Bendick, P. J., Shanley, C. J. (2004). Duplex Ultrasound Recognition of Spontaneous Carotid Dissection: A Case Report and Review of the Literature. VASC ENDOVASCULAR SURG 38: 455-460 [Abstract]  
• Calvet, D., Boutouyrie, P., Touze, E., Laloux, B., Mas, J.-L., Laurent, S. (2004). Increased Stiffness of the Carotid Wall Material in Patients With Spontaneous Cervical Artery Dissection. Stroke 35: 2078-2082 [Abstract] [Full Text]  
• Yu, N. R, Eberhardt, R. T, Menzoian, J. O, Urick, C. L, Raffetto, J. D (2004). Vertebral artery dissection following intravascular catheter placement: a case report and review of the literature. Vasc Med 9: 199-203 [Abstract]  
• Flemming, K. D., Brown, R. D. Jr, Petty, G. W., Huston, J. III, Kallmes, D. F., Piepgras, D. G. (2004). Evaluation and Management of Transient Ischemic Attack and Minor Cerebral Infarction. Mayo Clin Proc. 79: 1071-1086 [Abstract]  
• Badawi, R A, Birns, J, Ramsey, D J, Kalra, L (2004). Hiccups and bilateral carotid artery dissection. JRSM 97: 331-332 [Full Text]  
• Soo, O.-y. Y., Chan, Y. L., Wong, K. S. (2004). Carotid artery dissection after prolonged head tilting while holding a newborn baby to sleep. Neurology 62: 1647-1648 [Full Text]  
• Chen, C.-J., Tseng, Y.-C., Lee, T.-H., Hsu, H.-L., See, L.-C. (2004). Multisection CT Angiography Compared with Catheter Angiography in Diagnosing Vertebral Artery Dissection. Am. J. Neuroradiol. 25: 769-774 [Abstract] [Full Text]  
• Pride, G. L. Jr., Replogle, R. E., Rappard, G., Graybeal, C. L. T. D., White, J., Purdy, P. (2004). Stent-Coil Treatment of a Distal Internal Carotid Artery Dissecting Pseudoaneurysm on a Redundant Loop by Use of a Flexible, Dedicated Nitinol Intracranial Stent. Am. J. Neuroradiol. 25: 333-337 [Abstract] [Full Text]  
• Benninger, D.H., Georgiadis, D., Kremer, C., Studer, A., Nedeltchev, K., Baumgartner, R.W. (2004). Mechanism of Ischemic Infarct in Spontaneous Carotid Dissection. Stroke 35: 482-485 [Abstract] [Full Text]  
• Cohen, J. E., Leker, R. R., Gotkine, M., Gomori, M., Ben-Hur, T. (2003). Emergent Stenting to Treat Patients With Carotid Artery Dissection: Clinically and Radiologically Directed Therapeutic Decision Making. Stroke 34 : e254-e257 [Abstract] [Full Text]  
• Beletsky, V., Nadareishvili, Z., Lynch, J., Shuaib, A., Woolfenden, A., Norris, J. W. (2003). Cervical Arterial Dissection: Time for a Therapeutic Trial?. Stroke 34: 2856-2860 [Abstract] [Full Text]  
• Touze, E., Gauvrit, J.-Y., Moulin, T., Meder, J.-F., Bracard, S., Mas, J.-L. (2003). Risk of stroke and recurrent dissection after a cervical artery dissection: A multicenter study. Neurology 61: 1347-1351 [Abstract] [Full Text]  
• Cohen, J. E., Gomori, J. M., Umansky, F. (2003). Endovascular Management of Spontaneous Bilateral Symptomatic Vertebral Artery Dissections. Am. J. Neuroradiol. 24: 2052-2056 [Abstract] [Full Text]  
• Lewis, M J, Greenwood, R J, Brew, S, Jager, H R (2003). Economy class stroke syndromes: vertebral artery dissection revisited. J. Neurol. Neurosurg. Psychiatry 74: 1594-1595 [Full Text]  
• Sakaguchi, M., Kitagawa, K., Hougaku, H., Hashimoto, H., Nagai, Y., Yamagami, H., Ohtsuki, T., Oku, N., Hashikawa, K., Matsushita, K., Matsumoto, M., Hori, M. (2003). Mechanical compression of the extracranial vertebral artery during neck rotation. Neurology 61: 845-847 [Abstract] [Full Text]  
• Touze, E., Oppenheim, C., Zuber, M., Meary, E., Meder, J.F., Mas, J.L. (2003). Early asymptomatic recurrence of cervical artery dissection: Three cases. Neurology 61: 572-574 [Abstract] [Full Text]  
• Rossetti, A. O., Reichhart, M. D., Bogousslavsky, J. (2003). Central Horner's syndrome with contralateral ataxic hemiparesis: A diencephalic alternate syndrome. Neurology 61: 334-338 [Abstract] [Full Text]  
• Kelly, P.J., Furie, K.L., Kistler, J.P., Barron, M., Picard, E.H., Mandell, R., Shih, V.E. (2003). Stroke in young patients with hyperhomocysteinemia due to cystathionine beta-synthase deficiency. Neurology 60: 275-279 [Abstract] [Full Text]  
• Binaghi, S., Chapot, R., Rogopoulos, A., Houdart, E. (2002). Carotid stenting of chronic cervical dissecting aneurysm: A report of two cases. Neurology 59: 935-937 [Abstract] [Full Text]  
• Quintana, J. G., Drew, E. C., Richtsmeier, T. E., Davis, L. E. (2002). Vertebral artery dissection and stroke following neck manipulation by Native American healer. Neurology 58: 1434-1434 [Full Text]  
• Grond-Ginsbach, C., Wigger, F., Morcher, M., von Pein, F., Grau, A., Hausser, I., Brandt, T. (2002). Sequence analysis of the COL5A2 gene in patients with spontaneous cervical artery dissections. Neurology 58: 1103-1105 [Abstract] [Full Text]  
• Marietta, M., Bertesi, M., Rozzi, N., Cano, M. C., Vallone, S., Cappi, C., Pozzi, S., Torelli, G. (2002). Low-Molecular-Weight Heparin for Vertebral Artery Dissection. CLIN APPL THROMB HEMOST 8: 179-181 [Abstract]  
• Arnold, M., Nedeltchev, K., Sturzenegger, M., Schroth, G., Loher, T. J., Stepper, F., Remonda, L., Bassetti, C., Mattle, H. P. (2002). Thrombolysis in Patients With Acute Stroke Caused by Cervical Artery Dissection: Analysis of 9 Patients and Review of the Literature. Arch Neurol 59: 549-553 [Abstract] [Full Text]  
• Milhaud, D., de Freitas, G. R., van Melle, G., Bogousslavsky, J. (2002). Occlusion Due to Carotid Artery Dissection: A More Severe Disease Than Previously Suggested. Arch Neurol 59: 557-561 [Abstract] [Full Text]  
• Brandt, T., Grond-Ginsbach, C. (2002). Spontaneous Cervical Artery Dissection: From Risk Factors Toward Pathogenesis. Stroke 33: 657-658 [Full Text]  
• Pezzini, A., Del Zotto, E., Archetti, S., Negrini, R., Bani, P., Albertini, A., Grassi, M., Assanelli, D., Gasparotti, R., Vignolo, L. A., Magoni, M., Padovani, A. (2002). Plasma Homocysteine Concentration, C677T MTHFR Genotype, and 844ins68bp CBS Genotype in Young Adults With Spontaneous Cervical Artery Dissection and Atherothrombotic Stroke. Stroke 33: 664-669 [Abstract] [Full Text]  
• Di Duro, J. O., Ernst, E. (2001). Life-Threatening Complications From Spinal Manipulation Are Rare. Stroke 32 : 2440-2440 [Full Text]  
• Kalb, R., Beletsky, V., Norris, J. W., the Canadian Stroke Consortium, , Schievink, W. I. (2001). Spontaneous Dissection of the Carotid and Vertebral Arteries. NEJM 345: 467-467 [Full Text]