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Carotid and Vertebral Artery Dissection
  1. Marcel Arnold*,
  2. Marie-Germaine Bousser
  1. *Consultant Neurologist, Department of Neurology, University Hospital of Berne, Switzerland and
  2. Professor in Neurology, Department of Neurology, University Hospital, Lariboisière, Paris, France; E-mail: marcel.arnold{at}insel.ch

    Abstract

    INTRODUCTION

    Carotid and vertebral artery dissections are potentially disabling and yet probably under-diagnosed, and mainly seem to affect young and middle-aged people (Bogousslavsky et al. 1987). Our review focuses on the mechanisms, possible underlying causes, clinical manifestations, diagnostic tools, treatment and prognosis of both carotid and vertebral dissection.

    EPIDEMIOLOGY

    Cervical artery dissection accounts for up to 20% of strokes in patients under 30 years of age (Bogousslavsky et al. 1987). The incidence of carotid dissection is about 2–3 per 100 000 per year (Schievink et al. 1993; Giroud et al. 1995); the incidence of cervical dissection must be higher because these figures do not take into account vertebral dissection (about 25% of all dissections), dissections without ischaemic events (20% of extracranial dissections) or asymptomatic dissections. Furthermore, dissections may be overlooked because the clinical manifestations resolve spontaneously and are not necessarily familiar to many emergency physicians. Most studies report either

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