SPONTANEOUS CERVICAL ARTERY DISSECTION

The spontaneous cervical artery dissection (SCAD) is one of the main c auses of cerebro-vascular accident in the young adult. It may results from minor cervical trauma. The pathophysiological basis of the neurol ogical complications remain unclear. For that reason, the treatment of SCAD is often empirical. In a retrospective study (1984-1994), we hav e reviewed 20 cases admitted to Notre-Dame Hospital for a SCAD confirm ed by angiography. The initial clinical diagnosis was missed in 65% of the cases despite a suggestive symptomatology (headache 80%, hemipare sis 65% and Horner 45%). We have studied the clinical evolution as rel ated to blood pressure, volemia, haematocrit and the administered trea tment (aspirin, Coumadin). 60% of the patients (mean age 39) deteriora ted in the hours following their admission. Their was one death (5%) a nd 85% had neurological sequelae. This study suggest that SCAD is a po tentially serious disease. A delayed diagnosis may lead to a poor prog nosis. Early aggressive treatment aiming at an optimal cerebral perfus ion could improve the patients outcome.