title: Treatment issues in spontaneous cervicocephalic artery dissections.
abstract: The management of cervicocephalic arterial dissections raises many unsolved issues such as: how to best acutely treat patients who present with ischemic stroke or occasionally with sub-arachnoid hemorrhage? How to best prevent ischemic stroke in patients who present with purely local signs such as headache, painful Horner Syndrome or neck pain? How long and how should patients be treated after cervicocephalic arterial dissections? Can patients resume their sports activities and when? The consensus is that, given the well-established initial thromboembolic risk, an urgent antithrombotic treatment is required in patients with a recent nonhemorrhagic cervicocephalic arterial dissection, but the type of antithrombotic treatment - anticoagulants or aspirin - as well as the indication for a local arterial treatment such as angioplasty/stenting remain debated. Evidence from a randomized clinical trial would be welcome but such a trial raises major issues of methodology, feasibility and funding. Meanwhile, cervicocephalic arterial dissection remains a situation when a bedside clinician should use, on a case-by-case basis, best clinical judgment and adopt a stepped care approach in the minority of patients who deteriorate despite initial treatment.
authors.affiliation: Department of Neurology, University Hospital Berne, Inselspital, Berne, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.forename: Marie-Germaine
authors.initials: MG
authors.lastname: Bousser
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000628:therapy*; D001265:Athletic Injuries / Q000150:complications; D002545:Brain Ischemia / Q000150:complications; D002539:Cerebral Arterial Diseases / Q000150:complications / Q000628:therapy*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D020521:Stroke / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D020217:Vertebral Artery Dissection / Q000150:complications / Q000628:therapy*