title: Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts?
abstract: OBJECTIVE
  Cervical artery dissection (CeAD) is a major cause of ischemic stroke in young and middle-aged adults, although relatively uncommon in the community. Recent large collaborative projects have provided new insights into mechanisms and risk factors of CeAD.
  
  
  RESULTS
  Pathologic changes observed at the media-adventitia border in temporal arteries of CeAD patients suggest a predisposing arterial wall weakness. In large multicenter series of CeAD patients, compared to age-matched healthy controls and patients with an ischemic stroke of another cause, hypertension and migraine, especially without aura, were confirmed as risk factors for CeAD, in addition to cervical trauma and recent infection. Hypercholesterolemia and being overweight were shown to be inversely associated with CeAD. Differences in risk factor profile and structural features between carotid and vertebral dissection suggest that their pathophysiology may partly differ. An association of CeAD with fibromuscular dysplasia and reversible cerebral vasoconstriction syndrome was described. Genetic risk factors of CeAD are still poorly understood.
  
  
  CONCLUSIONS
  Large cohorts of CeAD patients have refined our understanding of the pathophysiology and risk factors of CeAD, but the molecular mechanisms are still poorly understood. Ongoing high-throughput genetic projects will hopefully provide novel insight into the biological substrate of CeAD.
authors.affiliation: aDepartment of Neurology, Lariboisière Hospital bInserm Unit U740 cParis 7 University, DHU Neurovasc Sorbonne Paris-Cité, Paris, France dDepartment of Neurology, Framingham Heart Study, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Debette
mesh_terms: D015331:Cohort Studies; D004777:Environment; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications; D008881:Migraine Disorders / Q000150:complications*; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D020217:Vertebral Artery Dissection / Q000453:epidemiology* / Q000209:etiology* / Q000235:genetics