eMedicine Specialties > Neurology > Neuro-vascular Diseases

Dissection Syndromes: Follow-up

Author: Chelsea S Kidwell, MD, Associate Professor, Department of Neurology, Georgetown University; Medical Director, Washington Hospital Center Stroke Center
Coauthor(s): Richard E Burgess, MD, PhD, Consulting Staff, Department of Neurology, Georgetown University Hospital, Consulting Staff, Suburban Hospital and Washington Hospital Center
Contributor Information and Disclosures

Updated: Dec 15, 2008

Follow-up

Further Inpatient Care

Pursue physical therapy, occupational therapy, speech therapy, and/or swallowing evaluation in appropriate patients.

Further Outpatient Care

  • Advise patients to avoid high-risk physical activities (eg, contact sports, yoga, chiropractic neck manipulation) to minimize the risk of recurrent dissection.
  • Transfer to a neurorehabilitation facility when appropriate.

Complications

The risk of recurrent dissection is approximately 1% per year. Recurrent dissections are more likely to occur in previously unaffected vessels than at the sites of previous dissections.

Prognosis

  • In extracranial carotid dissections, 50% of patients have no residual neurologic deficits, 20% have mild deficits, and 25% have moderate-to-severe residual deficits.
  • In intracranial carotid dissections, one half of survivors have moderate-to-severe residual deficits.
  • Of patients with extracranial vertebral dissections, 80-85% have mild neurologic deficits or are neurologically normal at the follow-up point. Moderate-to-severe deficits are found in 10%.
  • The morbidity and mortality rates for intracranial vertebrobasilar dissection are not well defined but tend to be higher due to increased occurrence of subarachnoid hemorrhage and brainstem infarction.

Miscellaneous

Medicolegal Pitfalls

Failure to consider the diagnosis, especially in a young patient

 
Acknowledgments

I would like to thank Jeffrey L. Saver, MD, for his thoughtful review of this article.



More on Dissection Syndromes

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Differential Diagnoses & Workup: Dissection Syndromes
Treatment & Medication: Dissection Syndromes
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Multimedia: Dissection Syndromes
References
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References

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Further Reading

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Keywords

alpha-1-antitrypsin deficiency, basilar artery dissection, cervical dissection, connective tissue disorders, cystic medial necrosis, Ehlers-Danlos syndrome, extracranial internal carotid artery dissection, extracranial vertebral artery dissection, intracranial internal carotid artery dissection, intracranial vertebral artery dissection, Marfan syndrome, meningovascular syphilis, middle cerebral artery dissection, moyamoya disease, type 1 collagen point mutation, dissection syndromes

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Contributor Information and Disclosures

Author

Chelsea S Kidwell, MD, Associate Professor, Department of Neurology, Georgetown University; Medical Director, Washington Hospital Center Stroke Center
Chelsea S Kidwell, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Society of Neuroimaging, and National Stroke Association
Disclosure: Nothing to disclose.

Coauthor(s)

Richard E Burgess, MD, PhD, Consulting Staff, Department of Neurology, Georgetown University Hospital, Consulting Staff, Suburban Hospital and Washington Hospital Center
Richard E Burgess, MD, PhD is a member of the following medical societies: American Academy of Neurology and American Heart Association
Disclosure: Nothing to disclose.

Medical Editor

William J Nowack, MD, Associate Professor, Department of Neurology, Epilepsy Center, University of Kansas Medical Center
William J Nowack, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Electroencephalographic Association, American Medical Informatics Association, and Biomedical Engineering Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching; Novartis Consulting fee Review panel membership

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health and Science University; Associate Director, Oregon Stroke Center
Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association
Disclosure: Co-Axia Consulting fee Review panel membership; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Boston Scientific Honoraria Speaking and teaching; Concentric Medical None Review panel membership; Northstar Neuroscience  Review panel membership; ev3 Consulting fee Review panel membership

 
 
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