Once considered rare, dissection of the internal carotid artery or vertebral artery is an increasingly recognized entity. Craniocervical arterial dissection is an uncommon cause of stroke in the general population, but is relatively common in patients below the age of 40. The early clinical manifestations are often subtle, however, permanent neurologic disability and death can result if the diagnosis is delayed. The present report describes eight patients (four men and four women) with dissection of the craniocervical arteries. Patient history was taken and clinical neurologic examinations were performed immediately upon admission. Diagnostic procedures included ultrasound (CDFI and TCD) and radiologic (computed 84 Journal Compilation © 2009 John Wiley & Sons tomography and digital subtraction angiography) examinations. The leading symptoms were focal neurologic deficits, and headache and neck ache. Ultrasound findings (CDFI) were positive for vessel dissection in seven (87.5%) patients, and DSA was consistent with dissection in five (62.5%) patients and negative in one patient, whereas in two patients this examination was not performed due to the known allergy to contrast medium. Five (62.5%) patients were treated with anticoagulants, one with platelet aggregation suppressants, and two patients were operated on. Six (75.0%) patients showed partial post-therapeutic recovery of neurologic deficits and improvement of ultrasound findings of dissected arteries. One patient developed a stroke postoperatively, with deterioration of the motor deficit, and one patient was readmitted 3 months later for a newly developed stroke and died soon thereafter. It is concluded that early detection of craniocervical arterial dissection is important to minimize the morbidity and mortality associated with this condition.
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