Vascular Dissection Syndromes

Dissections of arteries develop when there is blood extravasated within the medial or subintimal layers of the arterial wall with resultant compromise of the arterial lumen and development of a pseudoaneurysm. Vascular dissections can be associated with blunt trauma, penetrating trauma, or even trivial trauma. There are a number of associated conditions, including fibromuscular dysplasia, Marfan's syndrome, Ehlers-Danlos type IV syndrome, atherosclerosis, pronounced vessel tortuosity, moyamoya, cystic medial degeneration, pharyngeal infections, alpha -antitrypsin deficiency, and luetic arteritis. However, dissections may occur spontaneously. Cervicocephalic arterial dissections may present with ischemic stroke due to arterial occlusion or secondary embolization. The vessel that is most commonly involved is the extracranial carotid artery between C2 and the base of the skull. The vertebrobasilar system, intracranial carotid, and middle cerebral arteries are less frequently involved. y The patients may present with symptoms of transient retinal ischemia, hemispheric or posterior fossa ischemia, cerebral infarction, or subarachnoid hemorrhage. Pain along the forehead, eye, face, or neck may be present with carotid dissections. Vertebral dissections can cause pain in the occiput and neck. Other associated symptoms may include a Horner syndrome, audible bruits, and pulsatile tinnitus. Other cranial nerves that may be involved include II, Ill, V, VII, VIII, IX, X, XI, and Xll.y Diagnosis requires a high level of clinical suspicion that is confirmed with typical arteriographic signs (see Chapter.^. and Chapter ...50 ).

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