Skip to main content


Log in

University education and cervical artery dissection

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript


Background and purpose

We investigated whether university education is more likely in cervical artery dissection (CeAD)-patients than in age- and sex-matched patients with ischemic stroke (IS) due to other causes (non-CeAD-IS-patients).


Patients from the Cervical Artery Dissection and Ischemic Stroke Patients study with documented self-reported profession before onset of IS due to CeAD (n = 715) or non-CeAD causes (n = 631) were analyzed. In the reported profession, the absence or presence of university education was assessed. Professions could be rated as academic or non-academic in 518 CeAD and 456 non-CeAD patients. Clinical outcome at 3 months was defined as excellent if modified Rankin Scale was 0–1.


University education was more frequent in CeAD-patients (100 of 518, 19.3%) than in non-CeAD-IS-patients (61 of 456, 13.4%, p = 0.008). CeAD-patients with and without university education differed significantly with regard to smoking (39 vs. 57%, p = 0.001) and excellent outcome (80 vs. 66%, p = 0.004). In logistic regression analysis, university education was associated with excellent outcome in CeAD-patients (OR 2.44, 95% CI 1.37–5.38) independent of other outcome predictors such as age (OR 0.97, 95% CI 0.84–0.99), NIHSS (OR 0.80, 95% CI 0.76–0.84) and local signs (OR 2.77, 95% CI 1.37–5.57).


We observed a higher rate of university education in patients with CeAD compared with non-CeAD patients in our study population. University education was associated with favorable outcome in CeAD-patients. The mechanism behind this association remains unclear.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Addo J, Ayerbe L, Mohan KM, Crichton S, Sheldenkar A, Chen R et al (2012) Socioeconomic status and stroke: an updated review. Stroke J Cereb Circ 43(4):1186–1191 (PubMed PMID: 22363052)

    Article  Google Scholar 

  2. Lindmark A, Glader EL, Asplund K, Norrving B, Eriksson M, Riks-Stroke C (2014) Socioeconomic disparities in stroke case fatality—observations from Riks-Stroke, the Swedish stroke register. Int J Stroke Off J Int Stroke Soc 9(4):429–436 (PubMed PMID: 23981768)

    Article  Google Scholar 

  3. Galobardes B, Smith GD, Lynch JW (2006) Systematic review of the influence of childhood socioeconomic circumstances on risk for cardiovascular disease in adulthood. Ann Epidemiol 16(2):91–104 (PubMed PMID: 16257232)

    Article  PubMed  Google Scholar 

  4. Becher H, Palm F, Aigner A, Safer A, Urbanek C, Buggle F et al (2016) Socioeconomic conditions in childhood, adolescence, and adulthood and the risk of ischemic stroke. Stroke J Cerebral Circ 47(1):173–179 (PubMed PMID: 26604249)

    Article  Google Scholar 

  5. Debette S, Leys D (2009) Cervical-artery dissections: predisposing factors, diagnosis, and outcome. Lancet Neurol 8(7):668–678 (PubMed PMID: 19539238)

    Article  PubMed  Google Scholar 

  6. Investigators Ct, Markus HS, Hayter E, Levi C, Feldman A, Venables G et al (2015) Antiplatelet treatment compared with anticoagulation treatment for cervical artery dissection (CADISS): a randomised trial. Lancet Neurol 14(4):361–367 (PubMed PMID: 25684164)

    Article  Google Scholar 

  7. Rubinstein SM, Peerdeman SM, van Tulder MW, Riphagen I, Haldeman S (2005) A systematic review of the risk factors for cervical artery dissection. Stroke J Cereb Circ 36(7):1575–1580 (PubMed PMID: 15933263)

    Article  Google Scholar 

  8. Debette S, Metso T, Pezzini A, Abboud S, Metso A, Leys D et al (2011) Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults. Circulation 123(14):1537–1544 (PubMed PMID: 21444882)

    Article  CAS  PubMed  Google Scholar 

  9. Grau AJ, Brandt T, Buggle F, Orberk E, Mytilineos J, Werle E et al (1999) Association of cervical artery dissection with recent infection. Arch Neurol 56(7):851–856 (PubMed PMID: 10404987)

    Article  CAS  PubMed  Google Scholar 

  10. Guillon B, Berthet K, Benslamia L, Bertrand M, Bousser MG, Tzourio C (2003) Infection and the risk of spontaneous cervical artery dissection: a case-control study. Stroke J Cereb Circ 34(7):e79–e81 (PubMed PMID: 12805497)

    Article  Google Scholar 

  11. Grond-Ginsbach C, Lichy C, Debette S, Leys D, Pezzini A, Metso T et al (2015) Cervical artery dissection (CeAD) in physicians. Cerebrovasc Dis 39(1):72–74 (PubMed PMID: 25547424)

    Article  PubMed  Google Scholar 

  12. Johnston SC, Mendis S, Mathers CD (2009) Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 8(4):345–354 (PubMed PMID: 19233730)

    Article  PubMed  Google Scholar 

  13. Kerr GD, Slavin H, Clark D, Coupar F, Langhorne P, Stott DJ (2011) Do vascular risk factors explain the association between socioeconomic status and stroke incidence: a meta-analysis. Cerebrovasc Dis 31(1):57–63 (PubMed PMID: 20980755)

    Article  PubMed  Google Scholar 

  14. Engelter ST, Grond-Ginsbach C, Metso TM, Metso AJ, Kloss M, Debette S et al (2013) Cervical artery dissection: trauma and other potential mechanical trigger events. Neurology 80(21):1950–1957 (PubMed PMID: 23635964)

    Article  PubMed  Google Scholar 

  15. Maroon JC, Gardner P, Abla AA, El-Kadi H, Bost J (2007) “Golfer’s stroke”: golf-induced stroke from vertebral artery dissection. Surg Neurol 67(2):163–168 (discussion 8, PubMed PMID: 17254877)

    Article  PubMed  Google Scholar 

  16. Debette S, Metso TM, Pezzini A, Engelter ST, Leys D, Lyrer P et al (2009) CADISP-genetics: an International project searching for genetic risk factors of cervical artery dissections. Int J Stroke Off J Int Stroke Soc 4(3):224–230 (PubMed PMID: 19659826)

    Article  CAS  Google Scholar 

  17. Arrich J, Lalouschek W, Mullner M (2005) Influence of socioeconomic status on mortality after stroke: retrospective cohort study. Stroke J Cereb Circ 36(2):310–314 (PubMed PMID: 15625296)

    Article  Google Scholar 

Download references


CADISP (Cervical Artery Dissections and Ischemic Stroke Patients) Co-investigators: Massimo Pandolfo, M.D. Ph.D., Department of Neurology, Erasmus University Hospital, Brussels and Laboratory of Experimental Neurology, ULB, Brussels, Belgium; Marie Bodenant, M.D., Department of Neurology, Lille University Hospital–EA1046, France; Fabien Louillet, M.D. and Jean-Louis Mas, M.D. Ph.D., Department of Neurology, Sainte-Anne University Hospital, Paris, France; Sandrine Deltour, M.D. and Anne Léger, M.D., Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France; Sandrine Canaple, M.D. and Olivier Godefroy, M.D. Ph.D., Department of Neurology, Amiens University Hospital, France; Yannick Béjot, M.D. Ph.D., Department of Neurology, Dijon University Hospital, France; Thierry Moulin, M.D. Ph.D. and Fabrice Vuillier, M.D., Department of Neurology, Besançon University Hospital, France; Michael Dos Santos, M.D., Department of Neurology, University Hospital of Ludwigshafen, Germany; Ingrid Hausser, Ph.D., Department of Dermatology, Heidelberg University Hospital, Germany; Tobias Brandt M.D. Ph.D., Constanze Thomas-Feles, M.D., Kliniken-Schmieder, Heidelberg, Germany,; Valeria De Giuli M.D., Filomena Caria M.D., Loris Poli M.D., Alessandro Padovani M.D, PhD., Department of Neurology, Brescia University Hospital, Italy; Silvia Lanfranconi, M.D. and Pierluigi Baron, M.D. Ph.D., Department of Neurology, Milan University Hospital, Italy; Carlo Ferrarese, M.D. Ph.D., University of Milano Bicocca, San Gerardo Hospital, Monza, Italy; Giacomo Giacolone, M.D., Milan Scientific Institute San Raffaele University Hospital, Italy; Stefano Paolucci, M.D. Ph.D., Department of Rehabilitation, Santa Lucia Hospital, Rome, Italy; Felix Fluri, M.D., Florian Hatz, M.D., Dominique Gisler, M.D. and Margareth Amort, M.D., Department of Neurology, Basel University Hospital, Switzerland; Steve Bevan, Ph.D., Clinical Neuroscience, St George’s University of London, UK; Ayse Altintas, M.D. Ph.D., Department of Neurology, University Hospital of Istanbul, Turkey; Antti Metso, Ph.D., Marja Metso, Department of Neurology, Helsinki University Central Hospital.

Author information

Authors and Affiliations



Corresponding author

Correspondence to Lars Kellert.

Ethics declarations

Conflicts of interest

LK has received funding for travel and/or speaker honoraria from Bayer Vital, Boehringer Ingelheim, Bristal Myers Squibb, Daiichi Sankyo, and Pfizer. AG, AP, SD, DL, AB, TT, CT, CGG, MK report no disclosures. TMM has received funding from the Finnish Medical Foundation, Helsinki University Central Hospital Research Fund, Helsinki University Medical Foundation, Orion Farmos Research Foundation, Päivikki and Sakari Sohlberg Foundation, Maire Taponen Foundation, the Lilly Foundation, Paavo Ilmari Ahvenainen Foundation, Aarne and Aili Turunen Foundation, Aarne Koskelo Foundation, the Maud Kuistila Memorial Foundation, Emil Aaltonen Foundation, Finnish Brain Foundation, and Alfred Kordelin Foundation. VC has served as speaker for Boehringer Ingelheim, Sanofi, and Pfizer. VNT has received funding for travel or speaker honoraria from Bayer, Boehringer Ingelheim, Pfizer Inc and Medtronic; he has served on scientific advisory boards for Shire, Bayer, Pfizer and Boehringer Ingelheim and on the editorial board of Stroke. He is an associate editor of Acta Neurologica Belgica. He has received honoraria for being on the steering committee of the AX200 trial (SYGNIS). He has received research support from FWO Flanders. AB has received funding for travel and congresses participations from Shire, Boehringer Ingelheim, and Sanofi-aventis. ET has served on scientific advisory boards for Bayer Schering Pharma, Pfizer, BMS, and Shire; has received speaker honoraria from Boehringer Ingelheim, Bayer Schering Pharma, Pfizer, BMS, and Shire; has received funding for travel from Astra Zeneca and BMS; he serves as assistant editor for Stroke; and has received research support from the French Ministry of Health. PAL has served on scientific advisory boards for Bayer Schering Pharma, and Boehringer Ingelheim; has received funding for travel or speaker honoraria from Bayer Schering Pharma, Boehringer Ingelheim, and Shire plc; he serves as Co-Editor for Neurologie und Psychiatrie and on the editorial board of Swiss Archives of Neurology and Psychiatry; and has received research support from AstraZeneca, Boehringer Ingelheim, Sanofi-aventis, PhotoThera, the Swiss National Science Foundation, and the Swiss Heart Foundation. STE has received funding for travel or speaker honoraria from Bayer, Boehringer Ingelheim, Pfizer Inc, Sanofi-aventis, and Shire plc; he has served on scientific advisory boards for Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, and Pfizer and on the editorial board of Stroke. He has received research support from the Kaethe-Zingg-Schwichtenberg-Fonds of the Swiss Academy of Medical Sciences, the Swiss Heart Foundation, and Swiss National Science Foundation.

Ethical standard

The CADISP study protocol ( was approved by the relevant local authorities of all participating centers and is conducted according to the national rules concerning ethics committee approval and informed consent.

Additional information

CADISP (Cervical Artery Dissections and Ischemic Stroke Patients) Co-investigators are listed in Acknowledgements.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kellert, L., Grau, A., Pezzini, A. et al. University education and cervical artery dissection. J Neurol 265, 1065–1070 (2018).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: