title: Cervical artery dissection: trauma and other potential mechanical trigger events.
abstract: OBJECTIVE
  To examine the import of prior cervical trauma (PCT) in patients with cervical artery dissection (CeAD).
  
  
  METHODS
  In this observational study, the presence of and the type of PCT were systematically ascertained in CeAD patients using 2 different populations for comparisons: 1) age- and sex-matched patients with ischemic stroke attributable to a cause other than CeAD (non-CeAD-IS), and 2) healthy subjects participating in the Cervical Artery Dissection and Ischemic Stroke Patients Study. The presence of PCT within 1 month was assessed using a standardized questionnaire. Crude odds ratios (ORs) with 95% confidence intervals (CIs) and ORs adjusted for age, sex, and center were calculated.
  
  
  RESULTS
  We analyzed 1,897 participants (n = 966 with CeAD, n = 651 with non-CeAD-IS, n = 280 healthy subjects). CeAD patients had PCT in 40.5% (38.2%-44.5%) of cases, with 88% (344 of 392) classified as mild. PCT was more common in CeAD patients than in non-CeAD-IS patients (ORcrude 5.6 [95% CI 4.20-7.37], p < 0.001; ORadjusted 7.6 [95% CI 5.60-10.20], p < 0.001) or healthy subjects (ORcrude 2.8 [95% CI 2.03-3.68], p < 0.001; ORadjusted 3.7 [95% CI 2.40-5.56], p < 0.001). CeAD patients with PCT were younger and presented more often with neck pain and less often with stroke than CeAD patients without PCT. PCT was not associated with functional 3-month outcome after adjustment for age, sex, and stroke severity.
  
  
  CONCLUSIONS
  PCT seems to be an important environmental determinant of CeAD, but was not an independent outcome predictor. Because of the characteristics of most PCTs, the term mechanical trigger event rather than trauma may be more appropriate.
authors: Department of Neurology, Basel University Hospital, Basel, Switzerland.
authors: Stefan T
authors: ST
authors: Engelter
authors: Caspar
authors: C
authors: Grond-Ginsbach
authors: Tiina M
authors: TM
authors: Metso
authors: Antti J
authors: AJ
authors: Metso
authors: Manja
authors: M
authors: Kloss
authors: Stephanie
authors: S
authors: Debette
authors: Didier
authors: D
authors: Leys
authors: Armin
authors: A
authors: Grau
authors: Jean
authors: J
authors: Dallongeville
authors: Marie
authors: M
authors: Bodenant
authors: Yves
authors: Y
authors: Samson
authors: Valeria
authors: V
authors: Caso
authors: Alessandro
authors: A
authors: Pezzini
authors: Leo H
authors: LH
authors: Bonati
authors: Vincent
authors: V
authors: Thijs
authors: Henrik
authors: H
authors: Gensicke
authors: Juan J
authors: JJ
authors: Martin
authors: Anna
authors: A
authors: Bersano
authors: Emmanuel
authors: E
authors: Touzé
authors: Turgut
authors: T
authors: Tatlisumak
authors: Philippe A
authors: PA
authors: Lyrer
authors: Tobias
authors: T
authors: Brandt
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D020217:Vertebral Artery Dissection / Q000175:diagnosis* / Q000453:epidemiology*