Cervical Dissections Flashcards
What is the patho/plus of dissection
An intimal year in the vessel wall and the formation of an intramural hematoma sometimes associated with a pseudosneurysm
How is flow obstructed with a cervical dissection!
Compression of the lumen by the wall hematoma or by an intraluminal clot
What is the mechanism of stroke associated with a cervical dissection
Distal embolization downstream into the intracranial circulation
Where do most internal carotid Artery dissections occur?
- 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
What are some risk factors for cervical dissection?
- Head or neck trauma
- chiropractic manipulation
- MVA with whiplash and seatbelt injuries
- fibromuscular dysplasia
- inherited arteropathies Ehlers- Danlos syndrome
Why are subarachnoid hemorrhages common after cervical dissection?
Because as it extends intracranially, the blood vessels only have 2 layers vs 3 extracranially
What testing is used to diagnose a cervical dissection
- MRI T1 sequence with fat suppression
- CT angiogram
- Sigital subtraction angiogram. Gold standard
What is the treatment for cervical dissection?
- Anticoagulation for 3-6 months
- Most dissected arteries heal over time
- Stenting the lumen or coils in the pseudoaneurysm
