Cervical Dissections

Question 1

What is the patho/plus of dissection

Answer 1

An intimal year in the vessel wall and the formation of an intramural hematoma sometimes associated with a pseudosneurysm

Question 2

How is flow obstructed with a cervical dissection!

Answer 2

Compression of the lumen by the wall hematoma or by an intraluminal clot

Question 3

What is the mechanism of stroke associated with a cervical dissection

Answer 3

Distal embolization downstream into the intracranial circulation

Question 4

Where do most internal carotid Artery dissections occur?

Answer 4

• 2 or more ck distal to the carotid bifurcation

- in the vertebral artery at the c1-2 level where the artery leaves the transverse canal of the axis bone

Question 5

What are some risk factors for cervical dissection?

Answer 5

• Head or neck trauma
• chiropractic manipulation
• MVA with whiplash and seatbelt injuries
• fibromuscular dysplasia
• inherited arteropathies Ehlers- Danlos syndrome

Question 6

Why are subarachnoid hemorrhages common after cervical dissection?

Answer 6

Because as it extends intracranially, the blood vessels only have 2 layers vs 3 extracranially

Question 7

What testing is used to diagnose a cervical dissection

Answer 7

• MRI T1 sequence with fat suppression
• CT angiogram
• Sigital subtraction angiogram. Gold standard

Question 8

What is the treatment for cervical dissection?

Answer 8

• Anticoagulation for 3-6 months
• Most dissected arteries heal over time
• Stenting the lumen or coils in the pseudoaneurysm