Dissection Syndromes Follow-up
- Author: Chelsea S Kidwell, MD; Chief Editor: Helmi L Lutsep, MD more...
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.
Further Inpatient Care
Pursue physical therapy, occupational therapy, speech therapy, and/or swallowing evaluation in appropriate patients.
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.
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.
Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Differential features of carotid and vertebral artery dissections: The CADISP Study. Neurology. 2011 Sep 7. [Medline].
Paciaroni M, Bogousslavsky J. Cerebrovascular complications of neck manipulation. Eur Neurol. 2009. 61(2):112-8. [Medline].
Engelter ST, Dallongeville J, Kloss M, Metso TM, Leys D, Brandt T, et al. Thrombolysis in cervical artery dissection--data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database. Eur J Neurol. 2012 Sep. 19(9):1199-206. [Medline].
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].
Kim YK, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thromb Res. 2009 Apr. 123(6):810-21. [Medline].
Kennedy F, Lanfranconi S, Hicks C, Reid J, Gompertz P, Price C, et al. Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology. 2012 Aug 14. 79(7):686-9. [Medline].
Arauz A, Márquez JM, Artigas C, Balderrama J, Orrego H. Recanalization of vertebral artery dissection. Stroke. 2010 Apr. 41(4):717-21. [Medline].
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].
Debette S, Leys D. Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol. 2009 Jul. 8(7):668-78. [Medline].
Debette S, Markus HS. The genetics of cervical artery dissection: a systematic review. Stroke. 2009 Jun. 40(6):e459-66. [Medline].
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].
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].