Polyarterial clustered recurrence of cervical artery dissection seems to be the rule.
BACKGROUND
Spontaneous cervical artery dissection (sCAD) in multiple neck arteries (polyarterial sCAD) is traditionally thought to represent a monophasic disorder suggesting nearly simultaneous occurrence of the various intramural hematomas. Its incidence ranges from 10 to 28%. The recurrence rate of sCAD in general over up to 8.6 years has been recorded to be 0 to 8%.


OBJECTIVE
To analyze more precisely the temporal and spatial neuroangiologic course of sCAD with particular focus on polyarterial manifestation.


METHODS
We prospectively investigated 36 consecutive patients with sCAD unexceptionally proven by MR imaging at 1.5 T. We reinvestigated these patients by two follow-up MR examinations. The first follow-up MR examination was performed after a mean of 16 +/- 13 days, and the last MR study after a mean of 7 +/- 2 months after the initial diagnosis.


RESULTS
Systematic data evaluation of the 36 patients revealed the following phenomena of sCAD: 1) seemingly simultaneous polyarterial sCAD on the initial MRI scan (n = 2; 6%); 2) recurrent sCAD in one or several initially uninvolved cervical arteries during follow-up (n = 9; 25%). These latter sCAD occurred as an early polyarterial recurrent event within 1 to 4 weeks in 7 patients (19%), and as a delayed polyarterial recurrent event within 5 to 7 months in 2 patients (6%). Under a spatial perspective, sCAD recurrence took place in one additional cervical artery in 5 patients (14%), or in more than one previously uninvolved cervical artery in 4 patients (11%). All patients except one with sCAD recurrence remained asymptomatic or had local symptoms only. One patient experienced a significant clinical deterioration due to ischemic stroke with acute impairment of cerebral hemodynamics. During follow-up, patients received transient oral anticoagulation for at least 6 months with subsequent acetylsalicylic acid (ASA).


CONCLUSIONS
More often than previously thought, the recurrence of spontaneous cervical artery dissection (sCAD) involves multiple cervical arteries in sequence. sCAD recurrence frequently appears to cluster within the first 2 months after the index event, rather than occurring steadily over time. The prognosis of recurring sCAD appears benign, particularly in patients already receiving antithrombotic therapy.
Dittrich
R
R
Department of Neurology, University Hospital of Muenster, Muenster, Germany. dittrir@gmx.de
Nassenstein
I
I
Bachmann
R
R
Maintz
D
D
Nabavi
D G
DG
Heindel
W
W
Kuhlenbäumer
G
G
Ringelstein
E B
EB
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002343:Carotid Artery, Internal / Q000473:pathology* / Q000503:physiopathology; D020215:Carotid Artery, Internal, Dissection / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D055502:Secondary Prevention; D013029:Space-Time Clustering; D013997:Time Factors; D014711:Vertebral Artery / Q000473:pathology* / Q000503:physiopathology; D020217:Vertebral Artery Dissection / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology
D000925:Anticoagulants