title: Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection.
abstract: Spontaneous intracranial artery dissection is an uncommon and probably underdiagnosed cause of stroke that is defined by the occurrence of a haematoma in the wall of an intracranial artery. Patients can present with headache, ischaemic stroke, subarachnoid haemorrhage, or symptoms associated with mass effect, mostly on the brainstem. Although intracranial artery dissection is less common than cervical artery dissection in adults of European ethnic origin, intracranial artery dissection is reportedly more common in children and in Asian populations. Risk factors and mechanisms are poorly understood, and diagnosis is challenging because characteristic imaging features can be difficult to detect in view of the small size of intracranial arteries. Therefore, multimodal follow-up imaging is often needed to confirm the diagnosis. Treatment of intracranial artery dissections is empirical in the absence of data from randomised controlled trials. Most patients with subarachnoid haemorrhage undergo surgical or endovascular treatment to prevent rebleeding, whereas patients with intracranial artery dissection and cerebral ischaemia are treated with antithrombotics. Prognosis seems worse in patients with subarachnoid haemorrhage than in those without.
authors.affiliation: Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France; Inserm U897, Bordeaux University, France. Electronic address: stephanie.debette@u-bordeaux.fr.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Debette
authors.affiliation: Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands.
authors.forename: Annette
authors.initials: A
authors.lastname: Compter
authors.affiliation: Department of Neuroradiology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France.
authors.forename: Marc-Antoine
authors.initials: MA
authors.lastname: Labeyrie
authors.affiliation: Departments of Neurology and Radiology, University Medical Centre Groningen, Groningen, Netherlands.
authors.forename: Maarten
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authors.lastname: Uyttenboogaart
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Tina M
authors.initials: TM
authors.lastname: Metso
authors.affiliation: Department of Neurology, University of Utah, Salt Lake City, UT, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Majersik
authors.affiliation: Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Goeggel-Simonetti
authors.affiliation: Department of Neurology and Stroke Centre, University Hospital of Basel, Basel, Switzerland; Neurorehabilitation Unit, University Centre for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, Basel, Switzerland.
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
authors.affiliation: Department of Clinical and Experimental Sciences, Neurology Clinic, Brescia University Hospital, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzini
authors.affiliation: Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland.
authors.forename: Philippe
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authors.lastname: Bijlenga
authors.affiliation: Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Southerland
authors.affiliation: Department of Neuroradiology, Université Paris-Descartes, INSERM UMR 894, Center Hospitalier Sainte-Anne, DHU Neurovasc Paris Sorbonne, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Naggara
authors.affiliation: Department of Neurology, Dijon University Hospital, Dijon, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Béjot
authors.affiliation: Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Cole
authors.affiliation: Department of Neurology, Gui de Chauliac Hospital, Montpellier I University, Montpellier, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Ducros
authors.affiliation: Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele, Milano, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Giacalone
authors.affiliation: Inserm U897, Bordeaux University, France.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Schilling
authors.affiliation: Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France.
authors.forename: Peggy
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authors.lastname: Reiner
authors.affiliation: Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland; Department of Neurology, University Hospital of Zürich, Zürich, Switzerland.
authors.forename: Hakan
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authors.lastname: Sarikaya
authors.affiliation: Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.
authors.forename: Janna C
authors.initials: JC
authors.lastname: Welleweerd
authors.affiliation: Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands.
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.affiliation: Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, Netherlands.
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: de Borst
authors.affiliation: Department of Neurology and Stroke Centre, University Hospital of Basel, Basel, Switzerland.
authors.forename: Leo H
authors.initials: LH
authors.lastname: Bonati
authors.affiliation: Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland.
authors.forename: Simon
authors.initials: S
authors.lastname: Jung
authors.affiliation: Department of Neurosciences, Experimental Neurology, Laboratory of Neurobiology, KU Leuven University of Leuven, Leuven, Belgium; VIB-Vesalius Research Center, Leuven, Belgium; Department of Neurology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Thijs
authors.affiliation: Department of Neurology, Sanatorio Allende, Cordoba, Argentina.
authors.forename: Juan J
authors.initials: JJ
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authors.affiliation: Clinics for Neurologic Rehabilitation, Kliniken Schmieder, Heidelberg, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Brandt
authors.affiliation: Department of Neurology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Caspar
authors.initials: C
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authors.affiliation: Department of Neurology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Manja
authors.initials: M
authors.lastname: Kloss
authors.affiliation: Department of Neurosurgery, Showa University, Tokyo, Japan.
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authors.affiliation: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Centre, Suita, Japan.
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authors.initials: JF
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authors.initials: VM
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authors.affiliation: Cerebrovascular Disease Unit, IRCCS Foundation C Besta Neurological Institute, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Bersano
authors.affiliation: Université Caen Basse Normandie, Inserm U919, Department of Neurology, CHU Côte de Nacre, Caen, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Touzé
authors.affiliation: Department of Neurology and Stroke Centre, University Hospital of Basel, Basel, Switzerland.
authors.forename: Philippe A
authors.initials: PA
authors.lastname: Lyrer
authors.affiliation: Department of Neurology, Lille University Hospital, Lille, France.
authors.forename: Didier
authors.initials: D
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authors.affiliation: Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France.
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authors.initials: H
authors.lastname: Chabriat
authors.affiliation: Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Markus
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authors.forename: Bradford B
authors.initials: BB
authors.lastname: Worrall
authors.affiliation: French Centre for Paediatric Stroke and EA3065, Saint-Etienne University Hospital, Saint-Etienne, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Chabrier
authors.affiliation: NeuroCentre, Clinic Hirslanden Zürich, Zürich, Switzerland.
authors.forename: Ralph
authors.initials: R
authors.lastname: Baumgartner
authors.affiliation: Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Turgut
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authors.lastname: Tatlisumak
authors.affiliation: Department of Neurology, University Hospital Inselspital and University of Bern, Bern, Switzerland.
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.affiliation: Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France.
authors.forename: Marie-Germaine
authors.initials: MG
authors.lastname: Bousser
mesh_terms: D006801:Humans; D020765:Intracranial Arterial Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy