Vertebral artery dissection: presenting findings and predictors of outcome.

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State: Public
Version: Final published version
Serval ID
serval:BIB_87788A626609
Type
Article: article from journal or magazin.
Collection
Publications
Title
Vertebral artery dissection: presenting findings and predictors of outcome.
Journal
Stroke
Author(s)
Arnold M., Bousser M.G., Fahrni G., Fischer U., Georgiadis D., Gandjour J., Benninger D., Sturzenegger M., Mattle H.P., Baumgartner R.W.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
2006
Peer-reviewed
Oui
Volume
37
Number
10
Pages
2499-2503
Language
english
Notes
Publication types: Journal Article Publication Status: ppublish
Abstract
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.
Keywords
Brain Ischemia/epidemiology, Brain Ischemia/etiology, Comorbidity, Databases, Factual, Diagnostic Imaging/methods, Diagnostic Imaging/statistics & numerical data, Female, Fibrinolytic Agents/therapeutic use, Follow-Up Studies, Humans, Hypercholesterolemia/epidemiology, Hypertension/epidemiology, Ischemic Attack, Transient/epidemiology, Ischemic Attack, Transient/etiology, Magnetic Resonance Imaging, Male, Prospective Studies, Retrospective Studies, Risk Factors, Rupture, Spontaneous, Severity of Illness Index, Subarachnoid Hemorrhage/epidemiology, Subarachnoid Hemorrhage/etiology, Thrombolytic Therapy, Tinnitus/epidemiology, Tinnitus/etiology, Treatment Outcome, Vertebral Artery Dissection/diagnosis, Vertebral Artery Dissection/drug therapy
Pubmed
Web of science
Open Access
Yes
Create date
08/10/2012 9:27
Last modification date
20/08/2019 14:46
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