title: Clinical characteristics of symptomatic vertebral artery dissection: a systematic review.
abstract: BACKGROUND
  Vertebral artery dissection (VAD) is an important cause of stroke in the young. It can present nonspecifically and may be misdiagnosed with adverse consequences. We assessed the frequency of head/neck pain, other neurological symptoms, and cerebrovascular events in symptomatic VAD.
  
  
  METHODS
  We conducted a systematic review of observational studies, searching electronic databases (MEDLINE, EMBASE) for English-language manuscripts with >5 subjects with clinical or radiologic features of VAD. Two independent reviewers selected studies for inclusion; a third adjudicated differences. Studies were assessed for methodological quality, and clinical data were abstracted. Pooled proportions were calculated.
  
  
  RESULTS
  Of 3996 citations, we screened 511 manuscripts and selected 75 studies describing 1972 VAD patients. The most common symptoms were dizziness/vertigo (58%), headache (51%), and neck pain (46%). Stroke was common (63%), especially with extracranial dissections (66% vs. 32%, P<0.0001), whereas transient ischemic attack (14%) and subarachnoid hemorrhage (10%) were uncommon. Subarachnoid hemorrhage was seen only with intracranial dissections (57% vs. 0%, P=0.003). Fewer than half of the patients had obvious trauma, and only 7.9% had a known connective tissue disease. Outcome was good (modified Rankin scale 0 to 1) in 67% and poor (modified Rankin scale 5 to 6) in 10% of patients.
  
  
  CONCLUSIONS
  VAD is associated with nonspecific symptoms such as dizziness, vertigo, headache, or neck pain. Ischemic stroke is the most common reported cerebrovascular complication. VAD should be considered in the diagnostic assessment of patients presenting with dizziness or craniocervical pain, even in the absence of other risk factors. Future studies should compare clinical findings as predictors in well-defined, undifferentiated populations of clinical VAD suspects.
authors.affiliation: Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
authors.forename: Priti
authors.initials: P
authors.lastname: Sharma
authors.forename: Karen A
authors.initials: KA
authors.lastname: Robinson
authors.forename: Martinson
authors.initials: M
authors.lastname: Arnan
authors.forename: Megan
authors.initials: M
authors.lastname: Tsui
authors.forename: Karim
authors.initials: K
authors.lastname: Ladha
authors.forename: David E
authors.initials: DE
authors.lastname: Newman-Toker
mesh_terms: D004244:Dizziness / Q000209:etiology; D006261:Headache / Q000209:etiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology; D020521:Stroke / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D020217:Vertebral Artery Dissection / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D014717:Vertigo / Q000209:etiology