title: Negative ultrasound findings in patients with cervical artery dissection. Negative ultrasound in CAD.
abstract: BACKGROUND
  Cervical artery dissection (CAD) is a common cause of ischemic stroke in the younger age group. Modern imaging techniques allow the depiction of the mural hematoma, even in CADs with only subtle vessel alterations. The aim of this retrospective study was (1) to characterize the angiological features in CAD and (2) to determine the frequency of initially normal ultrasonography (US) findings.
  
  
  METHODS
  86 patients aged 44 +/- 11 years with CAD of the internal carotid (ICA), (n = 55) or the vertebral artery (VA), (n = 31), admitted to our hospital within 8 days (mean 1.6 days) of symptom onset, were included. CAD was confirmed either by CT-angiography, MRI of the neck, MR-angiography or digital substraction angiography (DSA) and was compared with the results of the initial as well as repeated US examinations of the arteries supplying the brain.
  
  
  RESULTS
  In 75 patients (81.2 %) signs of vessel stenosis or occlusion were found while 11 patients (12.8%) with CAD of the ICA (n = 9) and the VA (n = 2) had normal US findings. The site of dissection in the US negative patients was highly variable without a predilection site. In 2 of 7 patients with repeated US examinations, complete vessel occlusion was found on follow-up, while in 5 patients again normal results were found. In four patients, there were changing findings in two alternative confirming imaging methods (MRI/DSA, CT/MRI) and in one patient conflicting findings (CT/MRI). Brain infarctions had occurred in 7 of the initially sonographically normal patients while the other 4 had suffered from transient (n = 2) or local (n = 2) symptoms only.
  
  
  CONCLUSIONS
  Approximately 1 out of 8 patients with subsequently proven CAD has negative initial neurovascular US findings despite comprehensive examination. In patients with suspected CAD and negative US examination, repeated US examinations and further diagnostic imaging, especially MRI is necessary.
authors.affiliation: Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Strasse 33, 48129, Münster, Germany. dittrir@gmx.de
authors.forename: R
authors.initials: R
authors.lastname: Dittrich
authors.forename: R
authors.initials: R
authors.lastname: Dziewas
authors.forename: M A
authors.initials: MA
authors.lastname: Ritter
authors.forename: S P
authors.initials: SP
authors.lastname: Kloska
authors.forename: R
authors.initials: R
authors.lastname: Bachmann
authors.forename: I
authors.initials: I
authors.lastname: Nassenstein
authors.forename: G
authors.initials: G
authors.lastname: Kuhlenbaumer
authors.forename: W
authors.initials: W
authors.lastname: Heindel
authors.forename: E B
authors.initials: EB
authors.lastname: Ringelstein
authors.forename: D G
authors.initials: DG
authors.lastname: Nabavi
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D001794:Blood Pressure / Q000502:physiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex; D017585:Ultrasonography, Doppler, Transcranial