Cervicocerebral artery dissections

Objective-To determine the aetiology, frequency, presentation, and outcome of blunt cervicocerebral arterial dissection presentations. Patients and methods-Cases were retrospectively identified through the stro ke registers at Royal Melbourne Hospital (a tertiary teaching hospital) and Geelong Hospital (a regional referral centre). Medical notes were then rev iewed. Results-A total of 18 cases were identified, with ages ranging from 28 to 5 3 years. Fifty five pier cent of the injuries sustained were to the interna l carotid artery and 45% to the vertebral artery. The majority of the injur ies were either spontaneous or associated with trivial forces. Other causes included motor vehicle accidents, falls, and cervical manipulations. Fifty five per cent of patients complained of significant neck pain before prese ntation. Most patients had delayed presentations, with only 39% presenting on the day of the incident. Seventy eight per cent presented with a neurolo gical deficit. Initial computed tomography was normal ire 71% of patients. The majority of patients were managed with anticoagulation, and had minima; functional deficit: on discharge, Other treatment modalities included surg ery (one patient) and thrombolysis (two patients). One patient tvas managed conservatively. Conclusions-The incidence of blunt cervicocerebral arterial dissection is u nknown; however it is an uncommon diagnosis. The most common presentation i s that of a delayed neurological. event. Initial brain computed tomography is usually normal. Minimal adverse outcomes at discharge were noted in pati ents treated with anticoagulation only.