Extracranial and intracranial artery dissections: Experiences from a tertiary referral center

Çiğdem Deniz; Talip Asil; Abdulkadir Tunç

doi:10.5798/dicletip.497896

Extracranial and intracranial artery dissections: Experiences from a tertiary referral center

Öz

Background: Craniocervical artery dissection is an important cause of ischemic stroke especially in young and middle aged adults. In this study, we evaluated extracrainal and intracranial artery dissections in terms of etiologies, risk factors, stroke severity and functional outcomes.

Methods: A total of 29 patients who were diagnosed with ischemic stroke due to extracranial or intracranial artery dissections were enrolled to this study. The ischemic stroke diagnosis was confirmed with diffusion weighted magnetic resonance imaging in all patients. Computed tomography angiography, magnetic resonance angiography and digital subtraction angiography were used to demonstrate the dissection. Demographic findings, risk factors and presence of trauma were evaluated. National Institute of Health Score Scale (NIHSS) was used for stroke severity assessment at disease onset. Functional outcomes were measured with Modified Rankin Scale (mRS) at the 3rd month.

Results: Fifteen patients (51.72%) had carotid artery dissections while 12 patients (41.37%) had vertebral artery dissection (VAD), 1 (3.4%) had basilar artery dissection (BAD) and both VAD and BAD were seen in 1 patient (3.4%). Coagulopathy was detected in 12 patients (41.37%). Connective tissue disease was suspected in 3 patients (10.3%). In 6 patients, dissections occured after trauma. Nineteen patients (65.51%) presented with somatosensory deficits. The 3rd month mRS scores were in the range of 0-2 and no significant correlation was found in terms of risk factors, etiology and trauma history.

Conclusion: Arterial dissection should be kept in mind for the clinical presentation of ischemic stroke in young adults. We think that better understanding of the risk factors, etiologies and clinical presentation of the dissections and early diagnosis-proper treatments might yield improved clinical outcomes.

Anahtar Kelimeler

Stroke,dissection,etiology

Kaynakça

1. Perry BC, Al-Ali F. Spontaneous cervical artery dissection: the borgess classification. Front Neurol 2013; 4: 133.
2. Putaala J, Metso AJ, Metso TM, et al. Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry. Stroke 2009; 40: 1195-203.
3. Flis C, Jager H, Sidhu P. Carotid and vertebral artery dissections: clinical aspects, imaging features and endovascular treatment. Eur Radiol 2007; 17: 820-34.
4. Debette S, Metso T, Pezzini A, et al. Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults. Circulation 2011; 123: 1537-44.
5. Kaplan Y, Kamişli Ö, Altinayar S, Özcan C. What are the Predictors of Death in Patients With Cranio-Cervical Artery Dissection? Noro Psikiyatr Ars 2015; 52: 117-23.
6. Brandt T, Orberk E, Weber R, et al. Pathogenesis of cervical artery dissections: association with connective tissue abnormalities. Neurology 2001; 57: 24-30.
7. Konrad C, Müller GA, Langer C, et al. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. J Neurol 2004; 251: 1242-8.
8. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 2009; 8: 668-78.

9. Krishnamurthi RV, Moran AE, Feigin VL, et al. Stroke Prevalance, Mortality And Disability-Adjusted Life Years İn Adults Aged 20-64 Years İn 1990- 2013: Data From Global Burden Of Disease 2013 Study. Neuroepidemiology 2015; 45: 190-202.
10. Chen H, Hong H, Xing S, Liu G, Zhang A, Tan S, Zhang J, Zeng J. Intracranial versus extracranial artery dissection cases presenting with ischemic stroke. J Stroke Cerebrovasc Dis. 2015 Apr; 24: 852-9.
11. Kwon JY, Kim NY, Suh DC, Kang DW, Kwon SU, Kim JS. Intracranial and extracranial arterial dissection presenting with ischemic stroke: Lesion location and stroke mechanism. J Neurol Sci. 2015 Nov 15; 358: 371-6.
12. Engelter ST, Dallongeville J, Kloss M, et al. Thrombolysis in cervical artery dissection--data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database. Eur J Neurol 2012; 19: 1199-206.
13. Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS). J Physiother. 2014 Mar; 60: 61.
14. Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale: a systematic review. Stroke. 2009 Oct; 40: 3393-5.
15. Blum CA, Yaghi S. Cervical Artery Dissection: A Review of the Epidemiology, Pathophysiology, Treatment, and Outcome. Arch Neurosci 2015; 2. pii: e26670.
16. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 2001; 344: 898-906.
17. Divjak I, Slankamenac P, Jovićević M, et al. A Case Serıes Of 22 Patıents Wıth Internal Carotid Artery Dıssectıon. Med Pregl 2011; (11-12): 575-8.
18. Béjot Y, Aboa-Eboulé C, Debette S, et al. Characteristics and outcomes of patients with multiple cervical artery dissection. Stroke 2014; 45: 37-41.
19. Thanvi B, Munshi SK, Dawson SL, et al. Carotid and vertebral artery dissection syndromes. Postgrad Med J 2005; 81: 383-8.
20. Debette S, Goeggel Simonetti B, Schilling S, et al. Familial occurrence and heritable connective tissue disorders in cervical artery dissection. Neurology 2014; 83: 2023-31.
21. Amthor KF, Haslund A. Bilateral carotid artery dissection. Tidsskr Nor Laegeforen 2017; 137: 203.
22. Luo H, Liu B, Hu J, et al. Hyperhomocysteinemia and methylenetetrahydrofolate reductase polymorphism in cervical artery dissection: a meta-analysis. Cerebrovasc Dis 2014; 37: 313-22.
23. Konrad C, Müller GA, Langer C, et al. Plasma homocysteine, MTHFR C677T, CBS 844ins68bp, and MTHFD1 G1958A polymorphisms in spontaneous cervical artery dissections. J Neurol 2004; 251: 1242-8.
24. McColgan P, Sharma P. The genetics of carotid dissection: meta-analysis of a MTHFR/C677T common molecular variant. Cerebrovasc Dis 2008; 25: 561-5.
25. Fusco MR, Harrigan MR. Cerebrovascular dissections: a review. Part II: blunt cerebrovascular injury. Neurosurgery 2011; 68: 517-30.

Ayrıntılar

Birincil Dil

Türkçe

Konular

-

Bölüm

Araştırma Makalesi

Yazarlar

Çiğdem Deniz Bu kişi benim
0000-0003-1325-4328
Türkiye

Talip Asil Bu kişi benim
0000-0001-9563-9488
Türkiye

Abdulkadir Tunç ^*
0000-0002-9747-5285
Türkiye

Yayımlanma Tarihi

13 Aralık 2018

Gönderilme Tarihi

15 Aralık 2018

Kabul Tarihi

7 Eylül 2018

Yayımlandığı Sayı

Yıl 2018 Cilt: 45 Sayı: 4

DOI

https://doi.org/10.5798/dicletip.497896

IZ

https://izlik.org/JA45JR56BH

Kaynak Göster

RIS / Bibtex

APA

Deniz, Ç., Asil, T., & Tunç, A. (2018). Extracranial and intracranial artery dissections: Experiences from a tertiary referral center. Dicle Medical Journal, 45(4), 407-414. https://doi.org/10.5798/dicletip.497896

AMA

1.Deniz Ç, Asil T, Tunç A. Extracranial and intracranial artery dissections: Experiences from a tertiary referral center. diclemedj. 2018;45(4):407-414. doi:10.5798/dicletip.497896

Chicago

Deniz, Çiğdem, Talip Asil, ve Abdulkadir Tunç. 2018. “Extracranial and intracranial artery dissections: Experiences from a tertiary referral center”. Dicle Medical Journal 45 (4): 407-14. https://doi.org/10.5798/dicletip.497896.

EndNote

Deniz Ç, Asil T, Tunç A (01 Aralık 2018) Extracranial and intracranial artery dissections: Experiences from a tertiary referral center. Dicle Medical Journal 45 4 407–414.

IEEE

[1]Ç. Deniz, T. Asil, ve A. Tunç, “Extracranial and intracranial artery dissections: Experiences from a tertiary referral center”, diclemedj, c. 45, sy 4, ss. 407–414, Ara. 2018, doi: 10.5798/dicletip.497896.

ISNAD

Deniz, Çiğdem - Asil, Talip - Tunç, Abdulkadir. “Extracranial and intracranial artery dissections: Experiences from a tertiary referral center”. Dicle Medical Journal 45/4 (01 Aralık 2018): 407-414. https://doi.org/10.5798/dicletip.497896.

JAMA

1.Deniz Ç, Asil T, Tunç A. Extracranial and intracranial artery dissections: Experiences from a tertiary referral center. diclemedj. 2018;45:407–414.

MLA

Deniz, Çiğdem, vd. “Extracranial and intracranial artery dissections: Experiences from a tertiary referral center”. Dicle Medical Journal, c. 45, sy 4, Aralık 2018, ss. 407-14, doi:10.5798/dicletip.497896.

Vancouver

1.Çiğdem Deniz, Talip Asil, Abdulkadir Tunç. Extracranial and intracranial artery dissections: Experiences from a tertiary referral center. diclemedj. 01 Aralık 2018;45(4):407-14. doi:10.5798/dicletip.497896