Cervical artery dissection. Recent data and pathophysiological hypothesis.

Introduction. - Cervicocranial arterial dissection is a major cause of cere bral infarction in young subjects. Traumatic and infectious factors are fre quently suspected to be at the origin of cervicocranial artery dissection. However, they are usually too minor or too common to explain the vessel wal l split-off. Underlying arteriopathy predisposing to dissections is therefo re often suspected. Current knowledge and key points. - The hypothesis of an underlying arterio pathy is based in certain cases on either the discovery of hereditary conne ctive tissue disorders (or secondary signs of these diseases) or their freq uent association with vascular and cardiac morphological abnormalities, thu s suggesting extracellular matrix abnormalities. Current histological and b iochemical data do not suggest the existence of a unique form of the diseas e but rather indicate the presence of various matrix abnormalities that cou ld involve one of the fibrillar components or its enzymatic regulation. Future prospects and projects. - Classification of dissections according to the various vascular wall alterations would therefore permit to better def ine reccurrence and familial risks and to improve overall management of the patients. (C) 1999 Elsevier, Paris.