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POS09 Vertebral and carotid dissections: different clinical entities
  1. R Rolph,
  2. M Waltham,
  3. L Corfield
  1. Academic Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to rachelrolph{at}hotmail.com

Abstract

Objectives To clarify how carotid and vertebral dissections present. Presentation and outcome data were recorded for all cervical arterial dissections reported radiologically between 2005 and 2009.

Results 15 cases were identified. Symptoms associated with nine vertebral artery dissections were vomiting, vertigo and ataxia. All except one had cerebellar signs. On initial imaging, eight had cerebellar or medullary infarcts. The vertebral artery was narrowed in 4 and occluded in 5. On follow-up imaging the vertebral artery had completely recanalised in half the patients. Of the internal carotid artery (ICA) dissections, two were traumatic, two spontaneous, one postpartum and one incidental. Traumatic precipitants were associated with Horner's syndrome: the remainder presented with headache, vomiting and hemiparesis. Imaging revealed acute infarcts in 2, partial ICA occlusion in 3, occlusion in 1 and an intimal flap in 1. On follow-up imaging: the distal ICA was ecstatic in 2 and recanalised in 2. Four experienced long-term neurological sequelae.

Conclusion Vertebral dissections present with cerebellar symptoms and posterior circulation infarcts. Although radiological resolution of the dissection is not universal, symptoms usually settle. ICA dissections are often precipitated, are inconsistent in presentation and less likely to have cerebral infarcts. Long-term symptoms and arterial dilation are more likely suggesting clinical and radiological follow-up is indicated.

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