title: Diagnosis and treatment of arterial dissections.
abstract: Dissections of the cervical and intracranial vessels represent an important source of stroke in those less than 50 years of age. This can occur spontaneously or following trauma, minor or major. Rapid diagnosis is essential to limit subsequent sequelae and modern computed tomographic angiography represents an appropriately sensitive modality. Treatment must be individualized to the patient and can consist of an antiplatelet regimen, anticoagulation, or endovascular intervention. No evidence demonstrates superiority of either medical modality and even aspirin alone may be efficacious. Consideration should be given to this in the multi-trauma population in which more aggressive anticoagulation is contraindicated. In addition, thrombolytic administration should not be withheld would it otherwise be indicated. Endovascular intervention is reserved for those with hemodynamically significant narrowing, enlarging pseudoaneurysms, fistulas formation, or subarachnoid hemorrhage.
authors.affiliation: Department of Neurosurgery, Tulane University School of Medicine, 131 S. Robertson St, 8047, New Orleans, LA, 70112, USA.
authors.forename: Ricky
authors.initials: R
authors.lastname: Medel
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Edison P
authors.initials: EP
authors.lastname: Valle-Giler
authors.forename: Sheryl
authors.initials: S
authors.lastname: Martin-Schild
authors.forename: Ramy
authors.initials: R
authors.lastname: El Khoury
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
mesh_terms: D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D020217:Vertebral Artery Dissection / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*