Cervical Artery Dissections: A Review.

BACKGROUND: Cervical artery dissection (CeAD) is an infrequent, yet potentially devastating, cause of stroke. While uncommon, CeAD is important for emergency physicians to quickly diagnose and treat because of the potential for cerebral ischemia, stroke, blindness, or death. To our knowledge, no review articles in the emergency medicine literature have been published on CeAD. A literature search of MEDLINE/PubMed, Embase, and other major abstracts in the English language was performed for the following terms: cervical artery, vertebral artery, and carotid artery dissection. The search included all titles from January 1, 2010 to February 28, 2015 and other relevant articles.

OBJECTIVES: We sought to review the epidemiology, pathophysiology, risk factors, and clinical presentation for extracranial CeAD in the adult population, explore recent research on diagnosing this disorder, evaluate the most current research on treatment options, and summarize the prognosis of CeAD.

DISCUSSION: CeAD is an uncommon but important cause of stroke in the young that is likely caused by multifactorial processes. The diagnosis should be considered in those with underlying risk factors, a remote history of minor trauma, and concerning signs and symptoms. The condition should be pursued via magnetic resonance imaging or computed tomography angiography. Treatment should be aimed at preventing additional complications, including recurrent stroke or transient ischemic attack, with antiplatelets, anticoagulants, or even endovascular or surgical therapy.

CONCLUSION: Overall, the prognosis of patients with CeAD is good, with relatively low death rates. However, the diagnosis should not be missed, because treatment may help prevent worsening or persistent ischemia, recurrent dissection, and death.