Treatment issues in spontaneous cervicocephalic artery dissections

Arnold, Marcel; Fischer, Urs; Bousser, Marie-Germaine (2011). Treatment issues in spontaneous cervicocephalic artery dissections. International journal of stroke, 6(3), pp. 213-8. Oxford: Blackwell Publishing 10.1111/j.1747-4949.2011.00605.x

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The management of cervicocephalic arterial dissections raises many unsolved issues such as: how to best acutely treat patients who present with ischemic stroke or occasionally with sub-arachnoid hemorrhage? How to best prevent ischemic stroke in patients who present with purely local signs such as headache, painful Horner Syndrome or neck pain? How long and how should patients be treated after cervicocephalic arterial dissections? Can patients resume their sports activities and when? The consensus is that, given the well-established initial thromboembolic risk, an urgent antithrombotic treatment is required in patients with a recent nonhemorrhagic cervicocephalic arterial dissection, but the type of antithrombotic treatment - anticoagulants or aspirin - as well as the indication for a local arterial treatment such as angioplasty/stenting remain debated. Evidence from a randomized clinical trial would be welcome but such a trial raises major issues of methodology, feasibility and funding. Meanwhile, cervicocephalic arterial dissection remains a situation when a bedside clinician should use, on a case-by-case basis, best clinical judgment and adopt a stepped care approach in the minority of patients who deteriorate despite initial treatment.

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 and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1747-4930

Publisher:

Blackwell Publishing

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:14

Last Modified:

29 Dec 2017 11:35

Publisher DOI:

10.1111/j.1747-4949.2011.00605.x

PubMed ID:

21557808

Web of Science ID:

000290316900009

URI:

https://boris.unibe.ch/id/eprint/3332 (FactScience: 206990)

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