title: Vertebral artery dissection: presenting findings and predictors of outcome.
abstract: 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.
authors.affiliation: Department of Neurology, Assistance Publique, Hôpitaux de Paris, Lariboisière, Paris, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Marie Germaine
authors.initials: MG
authors.lastname: Bousser
authors.forename: Gregor
authors.initials: G
authors.lastname: Fahrni
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgiadis
authors.forename: Joubin
authors.initials: J
authors.lastname: Gandjour
authors.forename: David
authors.initials: D
authors.lastname: Benninger
authors.forename: Matthias
authors.initials: M
authors.lastname: Sturzenegger
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Ralf W
authors.initials: RW
authors.lastname: Baumgartner
mesh_terms: 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*
chemical_list: D005343:Fibrinolytic Agents