Association of cervical artery dissection with recent infection

Background: Cervical artery dissection (CAD) is an important cause of ische mic stroke in younger patients. However, its cause is insufficiently unders tood. Objective: To test the hypothesis that CAD is frequently associated with re cent infection. Subjects and Methods: We compared the prevalence of infection during the pr eceding week in 43 consecutive patients with acute CAD and 58 consecutive p atients younger than 50 years with acute cerebral ischemia from other cause s (control patients). In subgroups of patients, we correlated infectious st atus with electron microscopic studies of skin biopsy specimens and investi gated pathways potentially linking infection and CAD. Results: Recent infection was more common in patients with CAD (25/43 [58.1 %]) than in control patients (19/58 [32.8%]; P = .01). Respiratory tract in fection was preponderant in both groups. Recent infection, but not the mech anical factors cough, sneezing, or vomiting, was independently associated w ith CAD in multivariate analysis. Investigation of serum antibodies against Chlamydia pneumoniae, smooth muscle cells, endothelial cells, collagen typ es I through IV, and heat shock protein 65 and assessment of serum alpha(1) -antitrypsin and HLA did not contribute to the understanding of the pathoge nesis of CAD. More patients with pathologic findings in skin biopsy specime ns tended to have had a recent infection (13/21 [62%]) than patients withou t pathologic findings (2/9 [22%]; P = .11). Conclusion: Our results suggest a significant association between recent in fection and CAD that is not explained by mechanical factors occurring durin g infection.