Dissection Syndromes Follow-up

  • Author: Chelsea S Kidwell, MD; Chief Editor: Helmi L Lutsep, MD   more...
 
Updated: Sep 19, 2011
 

Further Inpatient Care

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

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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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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, Georgetown University; Medical Director, Georgetown University 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  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.

Specialty Editor Board

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, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Electroencephalographic Association, American Medical Informatics Association, and Biomedical Engineering Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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: Nothing to disclose.

Chief Editor

Helmi L Lutsep, MD  Professor, Department of Neurology, Oregon Health and Science University School of Medicine; 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; AGA Medical Consulting fee Review panel membership; Concentric Medical Consulting fee Review panel membership

Additional Contributors

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

References

  1. 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. Sep 7 2011;[Medline].

  2. Paciaroni M, Bogousslavsky J. Cerebrovascular complications of neck manipulation. Eur Neurol. 2009;61(2):112-8. [Medline].

  3. Kim YK, Schulman S. Cervical artery dissection: pathology, epidemiology and management. Thromb Res. Apr 2009;123(6):810-21. [Medline].

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

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

  6. 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. Apr 2010;41(4):802-4. [Medline].

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

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

  9. 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. May 26 2009;72(21):1810-5. [Medline].

  10. Schwartz NE, Vertinsky AT, Hirsch KG, Albers GW. Clinical and radiographic natural history of cervical artery dissections. J Stroke Cerebrovasc Dis. Nov-Dec 2009;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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