Incidence and outcome of cervical artery dissection: a population-based study.
BACKGROUND
Incidence rates for internal carotid artery dissection (ICAD) have been reported to be 2.6 to 2.9 per 100,000, but reliable epidemiologic data for vertebral artery dissection (VAD) are not available.


OBJECTIVE
To determine the incidence rate of cervical artery dissection (CAD) in a defined population.


METHODS
With IRB approval, we used the medical record linkage system of the Rochester Epidemiology Project to identify all patients diagnosed with spontaneous ICAD and VAD for the period of 1987-2003 in Olmsted County, MN.


RESULTS
Of 48 patients with CAD, there were 32 patients with ICAD and 18 patients with VAD. In Olmsted County, the average annual incidence rate for ICAD was 1.72 per 100,000 population (95% CI, 1.13 to 2.32) and for VAD 0.97 per 100,000 population (95% CI, 0.52 to 1.4). The average annual incidence rate for CAD was 2.6 per 100,000 population (95% CI, 1.86 to 3.33). The most frequently encountered symptoms in CAD were head or neck pain (80%), cerebral ischemia (TIA or infarct) (56%), and Horner syndrome (25%). Good outcome (defined as modified Rankin score of 0 to 2) was seen in 92% of patients. No recurrence of dissection was observed during a mean 7.8 years of follow-up.


CONCLUSIONS
Internal carotid artery dissection was detected approximately twice as frequently as vertebral artery dissection in the overall study, but in the latter half of the study period, vertebral artery and internal carotid artery dissection incidence rates were equivalent. The majority of cervical artery dissection patients in the community have excellent outcome, and contrary to many tertiary referral series, re-dissection is rare.
Lee
Vivien H
VH
Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Brown
Robert D
RD
Mandrekar
Jayawant N
JN
Mokri
Bahram
B
D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000473:pathology / Q000503:physiopathology; D020215:Carotid Artery, Internal, Dissection / Q000453:epidemiology* / Q000628:therapy; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003240:Connective Tissue Diseases / Q000453:epidemiology; D005260:Female; D006732:Horner Syndrome / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology; D008910:Minnesota / Q000453:epidemiology; D019547:Neck Pain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000473:pathology / Q000503:physiopathology; D020217:Vertebral Artery Dissection / Q000453:epidemiology* / Q000628:therapy