Vertebral artery dissection: presenting findings and predictors of outcome

Arnold, Marcel; Bousser, Marie Germaine; Fahrni, Gregor; Fischer, Urs; Georgiadis, Dimitrios; Gandjour, Joubin; Benninger, David; Sturzenegger, Matthias; Mattle, Heinrich P; Baumgartner, Ralf W (2006). Vertebral artery dissection: presenting findings and predictors of outcome. Stroke, 37(10), pp. 2499-503. Baltimore, Md.: Lippincott Williams & Wilkins 10.1161/01.STR.0000240493.88473.39

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BACKGROUND AND PURPOSE: Few data exist about clinical, radiologic findings, clinical outcome, and its predictors in patients with spontaneous vertebral artery dissection (sVAD). METHODS: Clinical characteristics, imaging findings, 3-month outcomes, and its predictors were investigated in consecutive patients with sVAD. RESULTS: One hundred sixty-nine patients with 195 sVAD were identified. Brain ischemia occurred in 131 patients (77%; ischemic stroke, n=114, 67%; transient ischemic attack, n=17, 10%). Three patients with ischemic stroke showed also signs of subarachnoid hemorrhage (SAH); 3 (2%) had SAH without ischemia. The 134 patients with brain ischemia or SAH had head and/or neck pain in 118 (88%) and pulsatile tinnitus in seven (5%) patients. The remaining 35 patients (21%) had isolated head and/or neck pain in 21 (12%) cases, asymptomatic sVAD in 13 (8%), and cervical radiculopathy in one case (1%). Location of sVAD was more often in the pars transversaria (V2; 35%) or atlas loop (V3; 34%) than in the prevertebral (V1; 20%) or intracranial (V4; 11%) segment (P=0.0001). Outcome was favorable (modified Rankin scale score 0 or 1) in 88 (82%) of 107 ischemic stroke patients with follow up. Two (2%) patients died. Low baseline National Institutes of Health Stroke Scale score (P<0.0001) and younger age (P=0.007) were independent predictors of favorable outcome. CONCLUSIONS: sVAD is predominantly located in the pars transversaria (V2) or the atlas loop (V3). Most patients show posterior circulation ischemia. Favorable outcome is observed in most ischemic strokes and independently predicted by low National Institutes of Health Stroke Scale score and younger age.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Arnold, Marcel; Sturzenegger, Matthias and Mattle, Heinrich

ISSN:

0039-2499

ISBN:

16960096

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:46

Last Modified:

17 Mar 2015 21:45

Publisher DOI:

10.1161/01.STR.0000240493.88473.39

PubMed ID:

16960096

Web of Science ID:

000240938700017

URI:

https://boris.unibe.ch/id/eprint/19094 (FactScience: 1464)

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