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Dissection Syndromes Follow-up

  • Author: Chelsea S Kidwell, MD; Chief Editor: Helmi L Lutsep, MD  more...
 
Updated: Dec 08, 2015
 

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.

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Further Inpatient Care

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

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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.

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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.

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Contributor Information and Disclosures
Author

Chelsea S Kidwell, MD Professor, Department of Neurology, University of Arizona College of Medicine

Chelsea S Kidwell, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Society of Neuroimaging, National Stroke Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Neurological Association, American Society of Neurorehabilitation, American Academy of Neurology, American Heart Association, American Medical Association, National Stroke Association, Phi Beta Kappa, Tennessee Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.

Additional Contributors

William J Nowack, MD Associate Professor, Epilepsy Center, Department of Neurology, University of Kansas Medical Center

William J Nowack, MD is a member of the following medical societies: American Academy of Neurology, Biomedical Engineering Society, American Clinical Neurophysiology Society, American Epilepsy Society, EEG and Clinical Neuroscience Society, American Medical Informatics Association

Disclosure: Nothing to disclose.

Acknowledgements

Richard E Burgess, MD, PhD Assistant Professor, Department of Neurology, Georgetown University Hospital; Medical Director, Clinical Stroke Service

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.

References
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  4. Engelter ST, Rutgers MP, Hatz F, Georgiadis D, Fluri F, Sekoranja L. Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke. 2009 Dec. 40(12):3772-6. [Medline].

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  7. Arauz A, Márquez JM, Artigas C, Balderrama J, Orrego H. Recanalization of vertebral artery dissection. Stroke. 2010 Apr. 41(4):717-21. [Medline].

  8. Arnold M, Kurmann R, Galimanis A, Sarikaya H, Stapf C, Gralla J, et al. Differences in demographic characteristics and risk factors in patients with spontaneous vertebral artery dissections with and without ischemic events. Stroke. 2010 Apr. 41(4):802-4. [Medline].

  9. Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 2009 Jul. 8(7):668-78. [Medline].

  10. Debette S, Markus HS. The genetics of cervical artery dissection: a systematic review. Stroke. 2009 Jun. 40(6):e459-66. [Medline].

  11. Georgiadis D, Arnold M, von Buedingen HC, Valko P, Sarikaya H, Rousson V. Aspirin vs anticoagulation in carotid artery dissection: a study of 298 patients. Neurology. 2009 May 26. 72(21):1810-5. [Medline].

  12. Schwartz NE, Vertinsky AT, Hirsch KG, Albers GW. Clinical and radiographic natural history of cervical artery dissections. J Stroke Cerebrovasc Dis. 2009 Nov-Dec. 18(6):416-23. [Medline].

 
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Cerebral angiogram of a left internal carotid dissection showing gradual vessel tapering to occlusion.
Axial T1-weighted MRI demonstrating a crescent sign (arrow) in a patient with a left internal carotid artery dissection.
 
 
 
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