[Dissection of cervical arteries].

UNLABELLED

INDICENCE: Cervical artery dissection (CAD) is one of the major cause of cerebral infarction before 45 years of age. The average annual incidencerate is between 2.5 and 3 per 100,000, but the reported incidence of CAD is probably underestimated because of frequent asymptomatic forms, or producing only minor and local symptoms. Dissection of the internal carotid artery (ICA) is more frequent than dissection of the vertebral artery (VA) and intracranial dissection is less frequent than extracranial dissection.

PATHOGENESIS

Traumas and primary diseases of the arterial wall are the main predisposing factors, but the pathogenesis of spontaneous DAC remains unknown in most cases, although the possibility of an underlying arteriopathy is suspected.

CLINICAL AND RADIOLOGICAL MANIFESTATIONS

The clinical presentation of ICA dissections includes isolated local signs (Homer's sign, headaches) followed by a few hours or days later by signs of cerebral or retinal ischemia. Brainstem infarcts and occipital or cervical pain are the most strinking clinical feature of VA dissection. Recent progress in neuroradiology (i.e. CT-scan, MRI, magnetic resonance ongiography) and neurosonology (i.e. transcranial Doppler) allows a non invasive approach in the diagnosis and follow-up of CAD.

MANAGEMENT

The prognosis is highly variable, but remains usually good. Heparin in the acute stage, followed by an oral anticoagulant or aspirin treatment for 3 to 6 months is most commonly used, although it has never been proved by a randomized trial.