Carotid arterial dissection as a cause of severe brain infarction in young adults.
OBJECTIVE
To investigate the occurrence of cervicocerebral arterial dissection in young adults, we examined the etiology of first-ever brain infarction and the timing of angiography.


METHODS
One hundred eighty-four subjects with first stroke aged 16 to 49 years, admitted to the Helsinki University Hospital between 1983 and 1990 were included. Seventy-eight percent of the angiographies were performed more than 1 week after the onset of stroke symptoms.


RESULTS
We identified 19 (10%) subjects with carotid arterial dissection and none with vertebral arterial dissection. Mortality attributed to ischemic stroke caused by carotid arterial dissection was high (26%). With longer time between onset of stroke symptoms and angiography, dissection was a rarer finding (P < .01), and there were more angiographies with no findings (P < .05). Trauma (P < .001) and headache (P < .05) preceded onset of stroke more frequently in these patients than in others.


CONCLUSIONS
Prompt imaging of the cervicocerebral arteries is indicated if the patient has preceding trauma or complains of headache and/or neck pain.
Haapaniemi
H
H
Department of Neurology, University of Oulu, Oulu, Finland.
Salonen
O
O
Hillbom
M
M
Juvela
S
S