title: Extracranial and intracranial vertebral artery dissections: A comparison of clinical findings.
abstract: BACKGROUND
  The diagnostic criteria for extracranial vertebral artery dissection (VAD) have not been standardized among stroke centers. Recent studies have shown that extracranial (EVAD) and intracranial (IVAD) VAD may be different clinical entities. In this study, we reviewed clinical findings, including image findings of VAD cases, and compared these findings to EVAD and IVAD cases to highlight the clinical characteristics of EVAD.
  
  
  METHODS
  We searched our database to identify VAD cases registered between April 2008 and October 2014. We performed retrospective chart reviews to obtain detailed clinical information and compared clinical characteristics and radiological findings between EVAD and IVAD cases.
  
  
  RESULTS
  We identified 10 patients with EVAD and 113 patients with IVAD. Clinically, patients with EVAD had initial symptoms that included significantly higher frequencies of neck pain, nausea, and vertigo, whereas medical hypertension and alcohol consumption were more commonly associated with IVAD cases. EVAD cases were also more likely to manifest as ischemic stroke. Radiologically, intramural hematomas were more commonly observed by magnetic resonance imaging (MRI) in patients with EVAD, whereas MRI and computed tomography more frequently revealed aneurysm formation in IVAD cases.
  
  
  CONCLUSIONS
  Our data identified the clinical differences between patients with EVAD and IVAD. When relatively young patients complain of sudden-onset neck pain and/or other neurological symptoms, MRI studies may be useful to diagnose EVAD, especially when associated with mechanical stress.
authors.affiliation: Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan. Electronic address: tmorishita@fukuoka-u.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Morishita
authors.affiliation: Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan; Department of Neurology, Fukuoka University, Faculty of Medicine, Fukuoka, Japan.
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Ogata
authors.affiliation: Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan.
authors.forename: Juntaro
authors.initials: J
authors.lastname: Matsumoto
authors.affiliation: Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Okawa
authors.affiliation: Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Higashi
authors.affiliation: Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan.
authors.forename: Tooru
authors.initials: T
authors.lastname: Inoue
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002533:Cerebral Angiography; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015898:Tomography Scanners, X-Ray Computed; D020217:Vertebral Artery Dissection / Q000145:classification / Q000000981:diagnostic imaging*
keywords: Arterial dissection; Intramural hematoma; Neuroimaging; Stroke; Vertebral artery