Dissection Syndromes Follow-up

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

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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