Abstract
Cervical artery dissections may present with mild and misleading symptoms such as a headache or cervical pain. In the absence of early diagnosis and therapy, such patients may have a high risk of cerebrovascular events. In order to refine evaluation of cervical artery dissections, we report the experience of a single center, focusing on clinical findings (e.g., headache and pain-related features at onset). From 2012 to 2017, 49 patients with cervical arteries dissections were admitted to our institution; 28 out of 49 patients (57%) presented with a headache or cervical pain, which were evaluated according to the International Classification of Headache Disorders (ICHD-III beta). Item C3a of ICHD-III beta (“pain is severe and continuous for days or longer”) was present in all patients symptomatic for a headache. Another common characteristic was the recent onset, with an average (± SD) timing from the onset of a headache to the first neurologic evaluation of 3 (± 2) days (range 1–5). A refined clinical evaluation of patients presenting with a headache at the Emergency Department could improve the early detection and management of patients with cervical artery dissections, in particular when presenting without other associated neurological symptoms.
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References
Grond-Ginsbach C, Metso TM, Metso AJ, Pezzini A, Tatlisumak T, Hakimi M, Grau AJ, Kloss M, Lichy C (2013) Cervical artery dissection goes frequently undiagnosed. Med Hypotheses 80:787–790. https://doi.org/10.1016/j.mehy.2013.03.012
Giannini N, Ulivi L, Maccarrone M, Montano V, Orlandi G, Ferrari E, Cravcenco C, Bonuccelli U, Mancuso M (2017) Epidemiology and cerebrovascular events related to cervical and intracranial arteries dissection: the experience of the city of Pisa. Neurol Sci 38:1985–1991. https://doi.org/10.1007/s10072-017-3084-5
Gallerini S, Marsili L, Bartalucci M, Marotti C, Innocenti E, Marconi R (2017) An unusual cause of cervicobrachial pain: vertebral artery dissection. Neurol Sci 38:1111–1113. https://doi.org/10.1007/s10072-017-2847-3
Robertson JJ, Koyfman A (2017) Extracranial cervical artery dissections. Emerg Med Clin North Am 35:727–741. https://doi.org/10.1016/j.emc.2017.06.006
Bejot Y, Aboa-Ebolulè C, Debette S, Pezzini A, Tatlisumak T, Engelter S, Grond-Ginsbach C, Touzé E, Sessa M, Metso T, Metso A, Kloss M, Caso V, Dallongeville J, Lyrer P, Leys D, Giroud M, Pandolfo M, Abboud S, CADISP Group (2014) Characteristics and outcomes of patients with multiple cervical artery dissection. Stroke 45:37–41
Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J, CADISS trial investigators (2015) Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol 14:361–367. https://doi.org/10.1016/S1474-4422(15)70018-9
Bioussè V, D’Anglejan-Chatillon J, Toouboul PJ, Amarenco P, Bousser MG (1995) Time course of symptoms in extracranial carotid artery dissection: a series of 80 patients. Stroke 26:235–239
Kennedy F, Lanfranconi S, Hicks C, Reid J, Gompertz P, Price C, Kerry S, Norris J, Markus HS, Investigators CADISS (2012) Antiplatelets vs anticoagulation for dissection: CADISS nonrandomized arm and meta-analysis. Neurology 79:686–689. https://doi.org/10.1212/WNL.0b013e318264e36b
Morris NA, Merkler AE, Gialdini G, Kamel H (2017) Timing of incident stroke risk after cervical artery dissection presenting without ischemia. Stroke 48:551–555. https://doi.org/10.1161/STROKEAHA.116.015185
Gallerini S, Bartalucci M, Marconi R (2014) Letter by Gallerini et al regarding article, “characteristics and outcomes of patients with multiple cervical artery dissection”. Stroke 45:e90. https://doi.org/10.1161/STROKEAHA.114.005049
Headache Classification Committee of the International Headache Society (IHS) (2013) The international classification of headache disorders, 3rd edition (beta version). Cephalalgia 33:629–808. https://doi.org/10.1177/0333102413485658
Schytz HW, Ashina M, Magyari M, Larsen VA, Olesen J, Iversen HK (2014) Acute headache and persistent headache attributed to cervical artery dissection: field testing of ICHD-III beta. Cephalalgia 34:712–716
Arnold M, Cumurciuc R, Stapf C, Favrole P, Berthet K, Bousser MG (2006) Pain as the only symptom of cervical artery dissection. J Neurol Neurosurg Psychiatry 77:1021–1024
Uggetti C, Khouri Chalouhi K, Squarza S, Frediani F, Cariati M (2018) Headache in the emergency department: the role of imaging. Neurol Sci 39:151–152. https://doi.org/10.1007/s10072-018-3379-1
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Gallerini, S., Marsili, L., Bartalucci, M. et al. Headache secondary to cervical artery dissections: practice pointers. Neurol Sci 40, 613–615 (2019). https://doi.org/10.1007/s10072-018-3576-y
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DOI: https://doi.org/10.1007/s10072-018-3576-y