Vertebral artery dissection: presenting findings and predictors of outcome.
OBJECTIVE
Few data exist about clinical, radiologic findings, clinical outcome, and its predictors in patients with spontaneous vertebral artery dissection (sVAD).


METHODS
Clinical characteristics, imaging findings, 3-month outcomes, and its predictors were investigated in consecutive patients with sVAD.


RESULTS
One hundred sixty-nine patients with 195 sVAD were identified. Brain ischemia occurred in 131 patients (77%; ischemic stroke, n=114, 67%; transient ischemic attack, n=17, 10%). Three patients with ischemic stroke showed also signs of subarachnoid hemorrhage (SAH); 3 (2%) had SAH without ischemia. The 134 patients with brain ischemia or SAH had head and/or neck pain in 118 (88%) and pulsatile tinnitus in seven (5%) patients. The remaining 35 patients (21%) had isolated head and/or neck pain in 21 (12%) cases, asymptomatic sVAD in 13 (8%), and cervical radiculopathy in one case (1%). Location of sVAD was more often in the pars transversaria (V2; 35%) or atlas loop (V3; 34%) than in the prevertebral (V1; 20%) or intracranial (V4; 11%) segment (P=0.0001). Outcome was favorable (modified Rankin scale score 0 or 1) in 88 (82%) of 107 ischemic stroke patients with follow up. Two (2%) patients died. Low baseline National Institutes of Health Stroke Scale score (P<0.0001) and younger age (P=0.007) were independent predictors of favorable outcome.


CONCLUSIONS
sVAD is predominantly located in the pars transversaria (V2) or the atlas loop (V3). Most patients show posterior circulation ischemia. Favorable outcome is observed in most ischemic strokes and independently predicted by low National Institutes of Health Stroke Scale score and younger age.
Arnold
Marcel
M
Department of Neurology, Assistance Publique, Hôpitaux de Paris, Lariboisière, Paris, France.
Bousser
Marie Germaine
MG
Fahrni
Gregor
G
Fischer
Urs
U
Georgiadis
Dimitrios
D
Gandjour
Joubin
J
Benninger
David
D
Sturzenegger
Matthias
M
Mattle
Heinrich P
HP
Baumgartner
Ralf W
RW
D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D016208:Databases, Factual; D003952:Diagnostic Imaging / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000209:etiology; D015912:Thrombolytic Therapy; D014012:Tinnitus / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*
D005343:Fibrinolytic Agents