title: Characteristics and outcomes of patients with multiple cervical artery dissection.
abstract: OBJECTIVE
  Little is known about factors contributing to multiple rather than single cervical artery dissections (CeAD) and their associated prognosis.
  
  
  METHODS
  We compared the baseline characteristics and short-term outcome of patients with multiple to single CeAD included in the multicenter Cervical Artery Dissection and Ischemic Stroke Patients (CADISP) study.
  
  
  RESULTS
  Among the 983 patients with CeAD, 149 (15.2%) presented with multiple CeAD. Multiple CeADs were more often associated with cervical pain at admission (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.10-2.30), a remote history of head or neck surgery (OR, 1.87; 95% CI, 1.16-3.00), a recent infection (OR, 1.71; 95% CI, 1.12-2.61), and cervical manipulation (OR, 2.23; 95% CI, 1.26-3.95). On imaging, cervical fibromuscular dysplasia (OR, 3.97; 95% CI, 2.04-7.74) and the presence of a pseudoaneurysm (OR, 2.91; 95% CI, 1.86-4.57) were more often seen in patients with multiple CeAD. The presence of multiple rather than single CeAD had no effect on functional 3-month outcome (modified Rankin Scale score, ≥3; 12% in multiple CeAD versus 11.9% in single CeAD; OR, 1.20; 95% CI, 0.60-2.41).
  
  
  CONCLUSIONS
  In the largest published series of patients with CeAD, we highlighted significant differences between multiple and single artery involvement. Features suggestive of an underlying vasculopathy (fibromuscular dysplasia) and environmental triggers (recent infection, cervical manipulation, and a remote history of head or neck surgery) were preferentially associated with multiple CeAD.
authors: From the Department of Neurology, Dijon University Hospital, Dijon, France (Y.B., C.A.-E., M.G.); Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France (S.D., J.D.); Department of Neurology, EA1046, Lille University Hospital, Lille, France (S.D., D.L.); Department of Clinical and Experimental Sciences, Neurology Clinic, Brescia University Hospital, Brescia, Italy (A.P.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T., T.M., A.M.); Department of Neurology, University Hospital of Basel, Basel, Switzerland (S.E., P.L.); Department of Neurology, University Hospital of Heidelberg, Heidelberg, Germany (C.G.-G., M.K.); Department of Neurology, Sainte-Anne University Hospital, Paris, France (E.T.); Department of Neurology, San Raffaele University Hospital, Milan, Italy (M.S.); Stroke Unit, Perugia University Hospital, Italy (V.C.); and Laboratory of Experimental Neurology, Université Libre de Bruxelles, Brussels, Belgium (M.P., S.A.).
authors: Yannick
authors: Y
authors: Béjot
authors: Corine
authors: C
authors: Aboa-Eboulé
authors: Stéphanie
authors: S
authors: Debette
authors: Alessandro
authors: A
authors: Pezzini
authors: Turgut
authors: T
authors: Tatlisumak
authors: Stefan
authors: S
authors: Engelter
authors: Caspar
authors: C
authors: Grond-Ginsbach
authors: Emmanuel
authors: E
authors: Touzé
authors: Maria
authors: M
authors: Sessa
authors: Tiina
authors: T
authors: Metso
authors: Antti
authors: A
authors: Metso
authors: Manja
authors: M
authors: Kloss
authors: Valeria
authors: V
authors: Caso
authors: Jean
authors: J
authors: Dallongeville
authors: Philippe
authors: P
authors: Lyrer
authors: Didier
authors: D
authors: Leys
authors: Maurice
authors: M
authors: Giroud
authors: Massimo
authors: M
authors: Pandolfo
authors: Shérine
authors: S
authors: Abboud
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology / Q000628:therapy; D020215:Carotid Artery, Internal, Dissection / Q000473:pathology* / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology; D003627:Data Interpretation, Statistical; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck / Q000601:surgery; D019547:Neck Pain / Q000209:etiology; D016017:Odds Ratio; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000473:pathology* / Q000628:therapy*
keywords: outcome assessement; risk factors