title: Risk Factors and Clinical Presentation of Cervical Arterial Dissection: Preliminary Results of a Prospective Case-Control Study.
abstract: METHODS
  Cross-sectional case-control study.
  
  
  OBJECTIVE
  To identify risk factors and clinical presentation of individuals with cervical arterial dissection.
  
  
  BACKGROUND
  Cervical arterial dissection is a common cause of stroke in young people and has in rare cases been associated with cervical manipulative therapy. The mechanism is considered to involve pre-existing arterial susceptibility and a precipitating event, such as minor trauma. Identification of individuals at risk or early recognition of a dissection in progress could help expedite medical intervention and avoid inappropriate treatment.
  
  
  METHODS
  Participants were individuals 55 years of age or younger from the Hunter region of New South Wales, Australia with radiologically confirmed vertebral or internal carotid artery dissection and an age- and sex-matched comparison group. Participants were interviewed about risk factors, preceding events, and clinical features of their stroke. Physical examination of joint mobility and soft tissue compliance was undertaken.
  
  
  RESULTS
  Twenty-four participants with cervical arterial dissection and 21 matched comparisons with ischemic stroke but not dissection were included in the study. Seventeen (71%) of the 24 participants with dissection reported a recent history of minor mechanical neck trauma or strain, with 4 of these 17 reporting recent neck manipulative therapy treatment. Cardiovascular risk factors were uncommon, with the exception of diagnosed migraine. Among the participants with dissection, 67% reported transient ischemic features in the month prior to their admission for dissection.
  
  
  CONCLUSIONS
  Recent minor mechanical trauma or strain to the head or neck appears to be associated with cervical arterial dissection. General cardiovascular risk factors, with the exception of migraine, were not important risk factors for dissection in this cohort. Preceding transient neurological symptoms appear to occur commonly and may assist in the identification of this serious pathology.
  
  
  METHODS
  Prognosis, level 4.
authors.affiliation: School of Health Sciences, The University of Newcastle, Callaghan, Australia.
authors.forename: Lucy C
authors.initials: LC
authors.lastname: Thomas
authors.forename: Darren A
authors.initials: DA
authors.lastname: Rivett
authors.forename: John R
authors.initials: JR
authors.lastname: Attia
authors.forename: Christopher
authors.initials: C
authors.lastname: Levi
mesh_terms: D000328:Adult; D020215:Carotid Artery, Internal, Dissection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D042241:Early Diagnosis; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000009:adverse effects*; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications*; D009517:New South Wales / Q000453:epidemiology; D012307:Risk Factors; D054079:Vascular Malformations / Q000150:complications*; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*
keywords: cervical manipulation; internal carotid artery; neck; stroke; vertebral artery