title: Risk factors, radiological features, and infarct topography of craniocervical arterial dissection.
abstract: BACKGROUND
  Craniocervical arterial dissection is a common cause of ischemic stroke in the young to middle-aged population. There have been a number of previous studies where radiological features have been described but few with detailed mapping of infarct topography and none where these features have been related to the reported risk factors.
  
  
  OBJECTIVE
  The aims of this study were to describe the radiological characteristics of dissection patients ≤55 years and relate these to reported risk factors.
  
  
  METHODS
  Craniocervical arterial dissection cases ≤55 years, and age- and gender-matched controls were identified from a medical records database between 1998 and 2009. Control cases had stroke from another cause than dissection. Records and radiology were reviewed.
  
  
  RESULTS
  Thirty-six radiologically confirmed dissection cases [20 (56%) vertebral artery, 16 (44%) internal carotid], and 43 controls were identified. Dissections were extracranial with intracranial extension in 10 (28%) cases. Infarction was demonstrated in 22 (61%) dissection cases. The most common wall deficit identified was an intimal flap. Twenty-three (64%) dissection cases had a recent history of neck trauma (P > 0·000) and 13 (36%) had vascular variants (P = 0·013).
  
  
  CONCLUSIONS
  Craniocervical arterial dissection cases, particularly vertebral artery, were more likely to have a history of neck trauma. Dissections were most commonly extracranial, in the upper cervical region, with intracranial extension in 28%. Dissection cases with trauma more commonly had a dissection flap and evidence of infarction in the lateral medulla, anterior or posterior inferior cerebellar artery territory. Close inspection of the V3 segment of the vertebral or skull base for internal carotid artery may be warranted with a history of neck trauma.
authors.affiliation: Faculty of Health, School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Lucy Caroline
authors.initials: LC
authors.lastname: Thomas
authors.forename: Darren A
authors.initials: DA
authors.lastname: Rivett
authors.forename: Mark
authors.initials: M
authors.lastname: Parsons
authors.forename: Christopher
authors.initials: C
authors.lastname: Levi
mesh_terms: D000328:Adult; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D015898:Tomography Scanners, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000175:diagnosis*